RT Journal Article
T1 Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement.
A1 Faroux, Laurent
A1 Munoz-Garcia, Erika
A1 Serra, Vicenç
A1 Alperi, Alberto
A1 Nombela-Franco, Luis
A1 Fischer, Quentin
A1 Veiga, Gabriela
A1 Donaint, Pierre
A1 Asmarats, Lluis
A1 Vilalta, Victoria
A1 Chamandi, Chekrallah
A1 Regueiro, Ander
A1 Gutiérrez, Enrique
A1 Munoz-Garcia, Antonio
A1 Garcia Del Blanco, Bruno
A1 Bach-Oller, Montserrat
A1 Moris, Cesar
A1 Armijo, German
A1 Urena, Marina
A1 Fradejas-Sastre, Victor
A1 Metz, Damien
A1 Castillo, Pablo
A1 Fernandez-Nofrerias, Eduard
A1 Sabaté, Manel
A1 Tamargo, Maria
A1 Del Val, David
A1 Couture, Thomas
A1 Rodes-Cabau, Josep
K1 acute coronary syndrome
K1 coronary artery disease
K1 mortality
K1 percutaneous coronary intervention
K1 transcatheter aortic valve replacement
AB Scarce data exist on coronary events following transcatheter aortic valve replacement (TAVR), and no study has determined the factors associated with poorer outcomes in this setting. This study sought to determine the clinical characteristics, outcomes, and prognostic factors of acute coronary syndrome (ACS) events following TAVR. Multicenter cohort study including a total of 270 patients presenting an ACS after a median time of 12 (interquartile range, 5-17) months post-TAVR. Post-ACS death, myocardial infarction, stroke, and overall major adverse cardiovascular or cerebrovascular events were recorded. The ACS clinical presentation consisted of non-ST-segment-elevation myocardial infarction (STEMI) type 2 (31.9%), non-STEMI type 1 (31.5%), unstable angina (28.5%), and STEMI (8.1%). An invasive strategy was used in 163 patients (60.4%), and a percutaneous coronary intervention was performed in 97 patients (35.9%). Coronary access issues were observed in 2.5% and 2.1% of coronary angiography and percutaneous coronary intervention procedures, respectively. The in-hospital mortality rate was 10.0%, and at a median follow-up of 17 (interquartile range, 5-32) months, the rates of death, stroke, myocardial infarction, and major adverse cardiovascular or cerebrovascular events were 43.0%, 4.1%, 15.2%, and 52.6%, respectively. By multivariable analysis, revascularization at ACS time was associated with a reduction of the risk of all-cause death (hazard ratio, 0.54 [95% CI, 0.36-0.81] P=0.003), whereas STEMI increased the risk of all-cause death (hazard ratio, 2.06 [95% CI, 1.05-4.03] P=0.036) and major adverse cardiovascular or cerebrovascular events (hazard ratio, 1.97 [95% CI, 1.08-3.57] P=0.026). ACS events in TAVR recipients exhibited specific characteristics (ACS presentation, low use of invasive procedures, coronary access issues) and were associated with a poor prognosis, with a very high in-hospital and late death rate. STEMI and the lack of coronary revascularization determined an increased risk. These results should inform future studies to improve both the prevention and management of ACS post-TAVR.
YR 2020
FD 2020-01-29
LK http://hdl.handle.net/10668/15016
UL http://hdl.handle.net/10668/15016
LA en
DS RISalud
RD Apr 5, 2025