Clinical impact of the extent of jeopardized myocardium in patients undergoing transcatheter aortic valve intervention

Introduction and objectives: Coronary artery disease (CAD) is found in 30%-50% of patients with severe aortic stenosis (AS) undergoing treatment. The best management of CAD in AS patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear. We investigated the clinical impact of the extent of jeopardized myocardium in patients with concomitant CAD and severe AS treated by TAVI.Methods: Consecutive patients who underwent TAVI procedures at our hospital were identified. In the presence of CAD, the myocardium jeopardized before TAVI was graded using the British Cardiovascular Intervention Society (BCIS) jeopardy score (JS). The study population was divided in 3 groups: patients without concomitant CAD (no-CAD), patients with CAD and BCIS-JS = 4 (CAD BCIS-JS = 4) and patients with concomitant CAD and BCIS-JS > 4 (CAD BCIS-JS > 4). The primary study endpoint was major adverse cardiovascular and cerebrovascular events (MACCE).Results: A total of 403 patients entered the study: 223 no-CAD, 94 CAD BCIS-JS = 4 and 86 CAD BCIS-JS > 4. At > 3 months of follow-up [range 104-3296 days], patients without CAD and CAD patients with BCIS-JS =4 had better survival free from MACCE compared with those with less extensive revascularization (BCIS-JS > 4) (P = .049). This result was driven by a significant reduction in death (P = .031). On multivariate analysis, residual BCIS-JS < 4 and NYHA class III-IV independently predicted MACCE.Conclusions: In patients with concomitant CAD and severe AS, the extent of jeopardized myocardium before TAVI impacts on clinical outcomes.C 2022 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Automated summary

This study investigated the impact of the extent of jeopardized myocardium on clinical outcomes in patients with concomitant coronary artery disease (CAD) and severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The results showed that patients with less extensive revascularization had better survival free from major adverse cardiovascular and cerebrovascular events (MACCE). Therefore, adequate myocardial revascularization before TAVI is crucial for patients with CAD and severe AS.