Impact of coronary artery disease and percutaneous coronary intervention in women undergoing transcatheter aortic valve replacement: From the WIN-TAVI registry. in Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions / Catheter Cardiovasc Interv. 2019 May 1;93(6):1124-1131. doi: 10.1002/ccd.28012. Epub 2018 Dec 4.
2019
AO Ordine Mauriziano
Tipo pubblicazione
Observational Study
Autori/Collaboratori (29)Vedi tutti...
Naber C
Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Ferrer-Grazia MC
Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom.
Mikhail G
Department of Cardiology, Centro Cardiologico Monzino, Milan, Italy.
et alii...
Abstract
OBJECTIVES: To evaluate the impact of coronary artery disease (CAD) with or without recent (? 30 days) percutaneous coronary intervention (PCI) in women undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: Although women display a specific risk-profile for both PCI and TAVR, the impact of CAD and PCI in the setting of TAVR in women is unclear. METHODS: The multinational Women's International Transcatheter Aortic Valve implantation registry enrolled consecutive female patients undergoing contemporary TAVR in 19 centers between 2013 and 2015. Patients with available coronary angiography or CT scan in the pre-operative assessment of TAVR were categorized as without CAD, with CAD but no recent PCI and CAD and recent PCI (?30 days). All events were adjudicated according to the VARC-2 criteria. RESULTS: A total of 787 patients were included in this analysis, among whom 459 (58.3%) had no CAD, 247 (31.4%) had CAD without recent PCI and 81 (10.3%) underwent recent PCI (? 30 days before TAVR). After multivariable adjustment, both groups of CAD patients, without and with recent PCI, presented with higher risk of death, myocardial infarction or stroke, compared with patients without CAD ((adj) HR 1.56, 95%CI 1.03-2.39, P = 0.038 and (adj) HR 1.96, 95% CI 1.1-3.5, P = .021, respectively). Patients with recent PCI had increased risk of all-cause death ((adj) HR 1.89, 95% CI 1.0-3.5, P = 0.04) and stroke ((adj) HR 3.7, 95% CI 1.0-13.5, P = 0.046) compared with patients without CAD. CONCLUSION: The presence of CAD in women undergoing TAVR, with or without recent PCI, was associated with long-term poorer outcomes.
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PMID : 30511802
DOI : 10.1002/ccd.28012
Keywords
Sex Factors; Risk Assessment; Risk Factors; Prospective Studies; Registries; Myocardial Infarction/mortality; Percutaneous Coronary Intervention/adverse effects; Humans; Hemodynamics; Female; Coronary Artery Disease/diagnostic imaging/mortality/physiopathology/therapy; Calcinosis/diagnostic imaging/mortality/physiopathology/surgery; Aortic Valve Stenosis/diagnostic imaging/mortality/physiopathology/surgery; Aortic Valve/diagnostic imaging/pathology/physiopathology/surgery; Aged, 80 and over; Aged; Stroke/mortality; Time Factors; Transcatheter Aortic Valve Replacement/adverse effects/mortality; Treatment Outcome; aortic stenosis; gender issue; transcatheter aortic valve replacement;