GARZON Stefano (1,2), GARZON Stefano (1,2), MARIANI Jose (1), BEZERRA Felipe (1), PRADO Guy (1,2), BANDEIRA Willterson (1), ALMEIDA Breno (1), LEMOS Pedro (1)
(1) Hospital Israelita Albert Einstein, State of São Paulo, BRAZIL; (2) Universita' Degli Studi Di Roma La Sapienza, Metropolitan City of Rome Capital, ITALY
AIMS
To compare a CTA-based pre-TAVI assessment with selective CA and PCI strategy with guideline-oriented approach.
METHODS AND RESULTS
Methods
Retrospective, single-center observational study. All patients that underwent TAVI between January 2008 and June 2019 were screened and included if: 1) computed tomography angiography (CTA), coronary angiography (CA) and/or PCI data were available; 2) a follow-up of at least 5 years was completed. Patients were then allocated into two groups, depending on their pre-TAVI approach: i) group 1: pre-TAVI CA for all patients and PCI of all coronary lesions with ³ 70% stenosis; and ii) group 2: initial pre-TAVI CTA for all patients, with CA being performed selectively if at least one significant stenosis was found on a proximal, main epicardial coronary artery on CTA. In this group, PCI was performed at the discretion of the operator. We defined a combined endpoint of death by any cause, myocardial infarction, or unplanned revascularization.
Results
A total of 248 patients were included (150 patients in group 1 and 98 patients in group 2). Both groups were comparable in age (83 years vs. 81.5 years, p 0.121), hypertension (66.7% vs. 72.4%, p 0.336) and STS score (5.7 [3.1; 13.27] vs. 7.1 [3.4; 13.0], p 0.883). Diabetes was more common in group 2 (30% vs. 42.8%, p 0.038). There were no differences in the incidence of 1-, 2- or 3-vessel disease between groups (p 0.207). In group 1, all patients underwent CA, and 59.3% had at least one coronary stenosis. Of these lesions, all proximal, epicardial stenoses (42/89) underwent PCI. In group 2, 47 of 98 patients (48%) had at least one proximal, epicardial stenosis on CTA, and subsequently underwent CA. Of these, 45 patients (95.7%) had at least one coronary stenosis, and 32 (68.1%) underwent PCI. At 5 years, the combined endpoint occurred similarly between the two groups (41.2% vs. 29.9%, for groups 1 and 2, respectively, p 0.326). Likewise, when investigating only patients with coronary stenoses, we divided the sample according to revascularization status (non-PCI vs. PCI), the combined endpoint was also comparable between the groups (44.9% vs. 45.6%, p 0.239, respectively).
CONCLUSIONS
A pre-TAVI CTA approach with selective CA and PCI appears to be safe and might reduce the number of invasive coronary procedures prior to TAVI. Also, PCI of significant coronary stenoses before TAVI does not appear to have an impact on the combined endpoint at 5 years of follow-up.