Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation
Open accessAbstract
AIM: The aim of this study was to evaluate whether coronary artery disease (CAD) severity exerts a gradient of risk in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: A total of 445 patients with severe AS undergoing TAVI were included into a prospective registry between 2007 and 2012. The preoperative SYNTAX score (SS) was determined from baseline coronary angiograms. In case of revascularization prior to TAVI, residual SS (rSS) was also determined. Clinical outcomes were compared between patients without CAD (n = 158), patients with low SS (0-22, n = 207), and patients with high SS (SS > 22, n = 80). The pre-specified primary endpoint was the composite of cardiovascular death, stroke, or myocardial infarction (MI). At 1 year, CAD severity was associated with higher rates of the primary endpoint (no CAD: 12.5%, low SS: 16.1%, high SS: 29.6%; P = 0.016). This was driven by differences in cardiovascular mortality (no CAD: 8.6%, low SS: 13.6%, high SS: 20.4%; P = 0.029), whereas the risk of stroke (no CAD: 5.1%, low SS: 3.3%, high SS: 6.7%; P = 0.79) and MI (no CAD: 1.5%, low SS: 1.1%, high SS: 4.0%; P = 0.54) was similar across the three groups. Patients with high SS received less complete revascularization as indicated by a higher rSS (21.2 ± 12.0 vs. 4.0 ± 4.4, P < 0.001) compared with patients with low SS. High rSS tertile (> 14) was associated with higher rates of the primary endpoint at 1 year (no CAD:12.5%, low rSS: 16.5%, high rSS: 26.3%, P = 0.043). CONCLUSIONS: Severity of CAD appears to be associated with impaired clinical outcomes at 1 year after TAVI. Patients with SS > 22 receive less complete revascularization and have a higher risk of cardiovascular death, stroke, or MI than patients without CAD or low SS.
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The way coronary disease should influence decisions between TAVR and surgical valve replacement is unclear in some scenarios.
“The way in which coronary disease should influence decisions between valve replacement with TAVR versus surgical valve replacement is also unclear in some scenarios.”
From Calcific aortic stenosis (2016) · cites this paper as [248]
The Discussion (page unavailable) says it is debated whether the extent and complexity of coronary artery disease affect outcomes after TAVI, and contrasts TAVI patients with those undergoing surgical replacement. It does not directly address how coronary disease should determine the choice between TAVI and surgery; its stated uncertainty concerns outcomes and revascularization strategy among TAVI patients. (LLM, conf=0.83)
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Lindman, B. R., Clavel, M.-A., Mathieu, P., Iung, B., Lancellotti, P., Otto, C. M., & Pibarot, P. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.6 · Cited by 982 · see citing works
- Authors
- Stefanini, G. G., Stortecky, S., Cao, D., Rat-Wirtzler, J., O'Sullivan, C. J., Gloekler, S., Buellesfeld, L., Khattab, A. A., Nietlispach, F., Pilgrim, T., Huber, C., Carrel, T., Meier, B., Jüni, P., Wenaweser, P., & Windecker, S.
- Affiliations
- University Hospital of Bern (CH)
- University of Bern (CH)
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-03-28
- Volume
- 35
- Issue
- 37
- Pages
- 2530-2540
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2146250153
- Cited by
- 190
- References
- 33
- Citations by year
- 2026: 13 · 2025: 10 · 2024: 17 · 2023: 15 · 2022: 19 · 2021: 11 · 2020: 15 · 2019: 12 · 2018: 13 · 2017: 20 · 2016: 15 · 2015: 17 · 2014: 12 · 2012: 1
- FWCI
- 14.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- reroDoc Digital Library (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Open Access CRIS of the University of Bern
- Funders
- National Science Foundation
- University of Bern
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (140336, 135807, 33CM30-140 336, 32003B)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Keywords
- coronary artery disease severity, aortic stenosis, transcatheter aortic valve implantation, SYNTAX score, residual SYNTAX score, coronary revascularization, cardiovascular mortality, stroke, myocardial infarction, composite endpoints, risk stratification, coronary angiography, preoperative risk assessment, postoperative outcomes, transcatheter aortic valve
- MeSH terms
- Aged, 80 and over, Aortic Valve Stenosis, Coronary Artery Disease, Female, Heart Valve Prosthesis, Humans, Male, Myocardial Infarction, Prospective Studies, Severity of Illness Index, Treatment Outcome, Stroke, Transcatheter Aortic Valve Replacement
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