Mascherbauer Katharina Theresa Julia, Lamm Gudrun, Kammerlander Andreas Anselm, Will Maximilian, Nitsche Christian, Mousavi Roya Anahita, Demirel Caglayan, Bartko Philipp Emanuel, Schwarz Konstantin, Hengstenberg Christian, Mascherbauer Julia
Department of Internal Medicine 2, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100 Krems, Austria.
Eur Heart J Imaging Methods Pract. 2024 Oct 28;2(2):qyae096. doi: 10.1093/ehjimp/qyae096. eCollection 2024 Apr.
Coronary artery disease (CAD) remains one of the most frequent comorbidities among transcatheter aortic valve implantation (TAVI) candidates. Whether routine assessment of CAD by invasive coronary angiography (CA) and eventual peri-procedural percutaneous coronary intervention (PCI) is generally beneficial in TAVI patients has recently been heavily questioned. CA carries significant risks, such as kidney injury, bleeding, and prolonged hospital stay, and may frequently be unnecessary if significant stenoses of the proximal coronary segments can be ruled out on computed tomography angiography. Moreover, the benefits of pre-emptive coronary revascularization at the time of TAVI are not well defined. Despite these facts and weak guideline recommendations, CA and eventual PCI of stable significant coronary lesions at the time of TAVI remain common practice. However, ongoing randomized trials currently challenge the efficacy of such strategies to enable a more streamlined, individualized, and resource-sparing treatment with TAVI.
冠状动脉疾病（CAD）仍是经导管主动脉瓣植入术（TAVI）候选患者中最常见的合并症之一。通过有创冠状动脉造影（CA）对CAD进行常规评估以及最终在围手术期进行经皮冠状动脉介入治疗（PCI）对TAVI患者是否普遍有益，最近受到了严重质疑。CA存在重大风险，如肾损伤、出血和住院时间延长，如果在计算机断层扫描血管造影上可以排除近端冠状动脉节段的明显狭窄，CA可能常常是不必要的。此外，TAVI时进行预防性冠状动脉血运重建的益处尚不明确。尽管存在这些事实且指南建议薄弱，但TAVI时对稳定的明显冠状动脉病变进行CA及最终的PCI仍是常见做法。然而，正在进行的随机试验目前对这些策略的疗效提出了挑战，以便能通过TAVI实现更简化、个性化和节省资源的治疗。
