Phichaphop Asa, Okada Atsushi, Fukui Miho, Koike Hideki, Wang Cheng, Margonato Davide, Walser-Kuntz Evan, Stanberry Larissa I, Hamid Nadira, Cavalcante João L, Enriquez-Sarano Maurice, Lesser John R, Bapat Vinayak N, Sorajja Paul
Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
JACC Cardiovasc Interv. 2025 Jan 27;18(2):217-225. doi: 10.1016/j.jcin.2024.07.042. Epub 2024 Oct 23.
Assessment of coronary artery disease (CAD) is critical in managing severe aortic stenosis. Unplanned coronary angiography after TAVR, with or without percutaneous coronary intervention, may present significant challenges.
The aim of this study was to evaluate the incidence, predictors, and outcomes of unplanned coronary angiography after transcatheter aortic valve replacement (TAVR).
All TAVR procedures between July 2015 and December 2021 were examined for the occurrence of unplanned angiography and for procedural success with percutaneous coronary intervention if attempted, and a machine learning prediction model was created.
Among 1,444 patients (median age 81 years, 59% men), 6.7% had unplanned post-TAVR angiography, 45% within the first year. The most common indication was acute coronary syndrome, which occurred in 3.3% overall. Patients with preprocedural CAD (50.1%) had a significantly higher incidence of unplanned angiography (10.5% vs 2.9%; P < 0.001) in comparison with others. In multivariable analysis, factors associated with unplanned angiography were age (>75 years; HR: 0.46; 95% CI: 0.30-0.71; P < 0.001), mean aortic valve gradient (HR: 0.82; 95% CI: 0.68-0.98; P = 0.031), dialysis (HR: 2.68; 95% CI: 1.07-6.74; P = 0.036), and CAD (HR: 2.96; 95% CI: 1.76-4.98; P < 0.001). In multivariate models, these same variables had areas under the curve of 0.71 to 0.77 for 5-year prediction of unplanned angiography.
Unplanned angiography post-TAVR occurs in about 1 in 15 patients, with about one-half occurring within the first year, about one-half due to acute coronary syndrome, and pre-existing CAD being the strongest predictor. For those considering TAVR and who have or are at risk for CAD, a comprehensive strategy to facilitate lifetime management is needed.
评估冠状动脉疾病（CAD）对于严重主动脉瓣狭窄的管理至关重要。经导管主动脉瓣置换术（TAVR）后进行非计划冠状动脉造影，无论是否进行经皮冠状动脉介入治疗，都可能带来重大挑战。
本研究旨在评估经导管主动脉瓣置换术（TAVR）后非计划冠状动脉造影的发生率、预测因素及结果。
对2015年7月至2021年12月期间所有的TAVR手术进行检查，以确定非计划血管造影的发生情况以及如果尝试进行经皮冠状动脉介入治疗的手术成功率，并创建一个机器学习预测模型。
在1444例患者（中位年龄81岁，59%为男性）中，6.7%在TAVR后进行了非计划血管造影，其中45%在第一年内进行。最常见的指征是急性冠状动脉综合征，总体发生率为3.3%。与其他患者相比，术前患有CAD（50.1%）的患者非计划血管造影的发生率显著更高（10.5%对2.9%；P<0.001）。在多变量分析中，与非计划血管造影相关的因素包括年龄（>75岁；HR：0.46；95%CI：0.30-0.71；P<0.001）、平均主动脉瓣梯度（HR：0.82；95%CI：0.68-0.98；P=0.031）、透析（HR：2.68；95%CI：1.07-6.74；P=0.036）和CAD（HR：2.96；95%CI：1.76-4.98；P<0.001）。在多变量模型中，这些相同变量对非计划血管造影5年预测的曲线下面积为0.71至0.77。
TAVR后约每15例患者中有1例进行非计划血管造影，约一半发生在第一年内，约一半是由于急性冠状动脉综合征，而既往存在的CAD是最强的预测因素。对于那些考虑进行TAVR且患有CAD或有CAD风险的患者，需要一种全面的策略来促进终身管理。
