Impact of coronary artery disease in patients undergoing transcatheter aortic valve replacement: Insights from the FRANCE-2 registry - 05/01/18
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Résumé |
Objectives |
To assess the long term clinical impact of coronary artery disease (CAD) distribution in patients undergoing transcatheter aortic valve replacement (TAVR) using the FRench Aortic National CoreValve and Edwards (FRANCE-2) registry.
Background |
CAD is common in patients undergoing TAVR. However, the impact of CAD distribution before TAVR on short and long-term prognosis remains unclear.
Methods |
FRANCE-2 is a national French registry including all consecutive TAVR performed between 2010 and 2012 in 34 centres. Three-year mortality was assessed in relation to CAD status. CAD was define as at least one coronary stenosis>50%.
Results |
A total of 4201 patients were enrolled in the registry. For the present analysis, we excluded patients with a history of coronary artery bypass. CAD was reported in 1252 patients (30%). Half of patient presented with coronary multivessel disease. CAD extent was associated with an increase in cardiovascular risk-profile and in Logistic Euroscore (from 19.3±12.8% to 21.9±13.5%, P<0.001). Mortality at 30 days and 3 years was 9% and 44% respectively in the overall population. In multivariate analyses, neither the presence nor the extent of CAD was associated with mortality at 3 years (presence of CAD: HR 0.90; 95% CI 0.78 to 1.07). Significant lesion of the left anterior descending (LAD) was associated with higher 3-year mortality (HR 1.42; 95% CI 1.10 to 1.87). Similar results were found after propensity score matching (428 patients per group).
Conclusions |
CAD is not associated with decreased short and long-term survival in patients undergoing TAVR. The potential deleterious effect of LAD disease on long-term survival suggests the need for revascularization before or at the time of TAVR.
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Vol 10 - N° 1
P. 26-27 - janvier 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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