Background: Patients undergoing transcatheter aortic valve implantation (TAVI) have high prevalence of coronary artery disease (CAD), which is associated with worse outcomes. We sought to evaluate the effect of CAD severity and the pre TAVI completeness of revscularization on clinical outcomes in TAVI patients using the SYNTAX score (SS), the clinical SS (cSS) and the residual SYNTAX score (rSS).
Methods: a prospective registry of patients undergoing TAVI at our institution from 8/2008 to 11/2013 (n=287). Patients were classified as having concomitant CAD or no CAD and the CAD patients were stratified according to SS and cSS categories, in addition, the completeness of revascularization was stratified using the rSS. We compared 2 year clinical outcomes (death/myocardial infarction/cerebrovascular accident) between the no CAD vs. the CAD group stratified according to the SS/cSS/rSS using a cox proportional hazard ratio model adjusted for major clinical and demographic variables.
Results: 49 patients had CAD, these patients had a higher rate of the primary endpoint at 2 years (28.3% vs. 16.1% p=0.026), when stratified by severity – the difference was statistically significant only in the high severity CAD groups (75% vs. 16.1% p=0.002 for SS>22 and 41.2% vs.16.1% p=0.001 for cSS>63), and not in the low severity CAD patients (SS 8 had significantly higher incidence of the primary outcome in the overall CAD group (78.6% vs. 16.1% p<0.001). patients with a rSS
Conclusioins: in TAVI patients, it is CAD severity that is associated with worse prognosis and not the mere presence of CAD. More complete revascularization attenuates the negative effect of CAD . The SS and cSS can help identify patients who can benefit from more aggressive revascularization prior to TAVI.
