Wilimski Radosław, Huczek Zenon, Krauz Kamil, Rymuza Bartosz, Mazurek Maciej, Scisło Piotr, Zbroński Karol, Grodecki Kajetan, Kochman Janusz, Kuśmierczyk Mariusz
Department of Cardio-Thoracic Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland.
1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Postepy Kardiol Interwencyjnej. 2023 Sep;19(3):243-250. doi: 10.5114/aic.2023.131477. Epub 2023 Sep 27.
Coexistence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) raises questions regarding the safety and efficacy of TAVI in this subset of patients.
To evaluate the impact of previous coronary revascularization in terms of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on clinical outcomes after TAVI.
A total of 507 consecutive patients who underwent TAVI were divided into: non-revascularization (NR), post-PCI and post-CABG groups. The endpoints were established according to VARC-2 definitions.
Patients with previous coronary revascularization (36.7% of the population) were younger, more often male and their EuroSCORE II risk evaluation was significantly higher (NR 7.9% vs. post-PCI 8.0% vs. post-CABG 20.5%, < 0.0001). Patients after PCI or CABG prior to TAVI had similar 30-day all-cause mortality rates as those without coronary revascularization at baseline (NR vs. post-PCI vs. post-CABG: 8.1% vs. 5.5% vs. 6.8%, respectively; = 0.6). There were no differences in 12-month all-cause mortality rates between groups (NR vs. post-PCI vs. post-CABG: 15.3% vs. 14.2% vs. 16.9%, respectively; log-rank = 0.67). In the Cox proportional-hazards regression model, acute kidney injury stage 2-3 (HR = 3.7, 95% CI: 2.14-6.33; < 0.001) and post-TAVI stroke (HR = 3.5, 95% CI: 1.57-7.8; = 0.002) were independently correlated with 1-year mortality.
TAVI seems to be a safe and effective procedure for the treatment of severe AS in patients with previous coronary revascularization.
对于因严重主动脉瓣狭窄（AS）而接受经导管主动脉瓣植入术（TAVI）的患者，冠状动脉疾病（CAD）的并存引发了关于TAVI在这部分患者中的安全性和有效性的问题。
评估既往经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）进行冠状动脉血运重建对TAVI术后临床结局的影响。
将连续接受TAVI的507例患者分为：未血运重建（NR）组、PCI术后组和CABG术后组。终点根据VARC-2定义确定。
既往有冠状动脉血运重建的患者（占总体的36.7%）更年轻，男性比例更高，其欧洲心脏手术风险评估系统II（EuroSCORE II）风险评估显著更高（NR组7.9%，PCI术后组8.0%，CABG术后组20.5%，P<0.0001）。TAVI术前接受PCI或CABG的患者30天全因死亡率与基线时未进行冠状动脉血运重建的患者相似（NR组 vs. PCI术后组 vs. CABG术后组：分别为8.1%、5.5%和6.8%；P = 0.6）。各组间12个月全因死亡率无差异（NR组 vs. PCI术后组 vs. CABG术后组：分别为15.3%、14.2%和16.9%；对数秩检验P = 0.67）。在Cox比例风险回归模型中，急性肾损伤2-3期（HR = 3.7，95%CI：2.14-6.33；P<0.001）和TAVI术后卒中（HR = 3.5，95%CI：1.57-7.8；P = 0.002）与1年死亡率独立相关。
对于既往有冠状动脉血运重建的严重AS患者，TAVI似乎是一种安全有效的治疗方法。
