2 The impact of a conservative management strategy for stable coronary artery disease prior to TAVI Article Swipe
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· 2023
· Open Access
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· DOI: https://doi.org/10.1136/heartjnl-2023-ics.2
· OA: W4387520662
<h3>Background</h3> The optimum strategy for managing coronary artery disease (CAD) prior to transcatheter aortic valve implantation (TAVI) remains unclear. A recent consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the management of CAD in patients undergoing TAVI, recommended PCI before TAVI in patients with severe CAD (i.e. >70% stenosis in proximal segments of a major epicardial vessel or >50% stenosis in the left main coronary artery). We sought to assess the outcomes of a predominantly conservative management strategy for CAD in an Irish TAVI population 1 year after implantation. <h3>Aims</h3> The aim of this study was to assess the 1 year outcomes of a conservative management strategy for significant stable CAD prior to TAVI. <h3>Methods</h3> Single centre retrospective review of patients who underwent TAVI between 2014 and 2022 with a minimum of 1 year follow-up. The images and reports of coronary angiography performed prior to TAVI were analysed to identify patients who would be defined as severe CAD requiring intervention as per the EAPCI consensus statement recommendations. Local electronic medical records, discharge summaries, radiology and cardiology systems, and national death notification database were analysed for one year follow up data. The primary outcome for the study was major adverse cardiac events (MACE) at one year. The secondary outcomes for the study were mortality, myocardial infarction (MI), stroke, repeat angiography and revascularisation at one year. <h3>Results</h3> In total, 145 patients were included in the study (mean age 79.6 years, 35.9% female). The cohort had a high level of co-morbidities: 24.8% IHD, 40% HTN, 55.2% dyslipidaemia, 25.5% diabetes mellitus, 15.2% CKD, 35.9% atrial fibrillation/atrial flutter, 13.1% stroke/TIA. Nine patients (6.2%) underwent PCI prior to TAVI, 5 of whom (3.4%) had stable CAD. In the cohort with conservatively managed CAD, 19 (14%) had severe CAD meeting the EAPCI criteria for intervention. In the conservatively managed cohort, the incidence of MACE was 15.4%. There was no significant difference in the primary or secondary outcomes in patients with severe CAD, compared to patients without severe CAD (table 1). There was however a numerically higher incidence of stroke and numerically lower incidence of mortality, MI and revascularisation in the patients with severe CAD. <h3>Conclusion</h3> This study found a low incidence of major adverse cardiac events in patients with conservatively managed stable severe CAD at 1 year post TAVI, and similar outcomes to patients without severe CAD. This supports the safety of a heart team discussion guided conservative CAD management strategy while randomised control trial data is awaited.
