Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation

REVASC-TAVI Registry

doi:10.1161/CIRCINTERVENTIONS.122.012417

Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation

REVASC-TAVI Registry

Pathology Unit, Azienda Ospedaliero Universitaria Policlinico S. Orsola, Bologna, Italy
University of Bern
Hospital Clínico Universitario de Valladolid
University of Copenhagen
Kerckhoff Heart Center
Universidade de São Paulo
IRCCS S. Orsola University Hospital, Bologna, Italy
University of Ljubljana
Clinique Pasteur Toulouse
Department of Cardiology, Ramsay Generale de Sante, Institut Cardiovasculaire Paris Sud, Hopital Prive Jacques Cartier, Massy, France
Ospedale Policlinico
University of Galway
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Teikyo University
IRCCS Policlinico San Donato
GVM Care & Research
Technical University of Munich
University of Rome La Sapienza
Azienda Ospedaliera Universitaria Federico II
University of Catania
University of Turku
University of Cologne
San Martino Hospital Genoa
IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) - Palermo
Azienda Ospedaliera Universitaria Senese
Department of Neuroradiology, Policlinico di Bari, Bari, Italy
University of Vienna
Montefiore Health System
ASL TO4
University Hospital Zürich
universitá Ospedale "Ss. Annunziata

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. METHODS: The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. RESULTS: Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio‚ 0.88 [95% CI, 0.66–1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio‚ 0.97 [95% CI, 0.76–1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). CONCLUSIONS: The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.

Original language	English
Pages (from-to)	E012417
Journal	Circulation: Cardiovascular Interventions
Volume	15
Issue number	12
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.122.012417
Publication status	Published - 1 Dec 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

coronary artery disease
myocardial revascularization
outcome
percutaneous coronary intervention
transcatheter aortic valve implantation

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10.1161/CIRCINTERVENTIONS.122.012417

Management-of-myocardial-revascularization-in-patients-with-stable-coronary-artery-disease-undergoing-transcatheter-aort.pdfFinal published version, 1.19 MBLicence: Taverne

Cite this

@article{527a33606a454ee5b208fb79af6adff2,

title = "Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation",

abstract = "BACKGROUND: The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. METHODS: The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. RESULTS: Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6\% versus 18.2\%, hazard ratio‚ 0.88 [95\% CI, 0.66{\textendash}1.18]; P=0.38) and co-primary composite (29.0\% versus 27.1\%, hazard ratio‚ 0.97 [95\% CI, 0.76{\textendash}1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4\%, angina at baseline, diabetes, left ventricular ejection fraction > or <40\%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). CONCLUSIONS: The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.",

keywords = "coronary artery disease, myocardial revascularization, outcome, percutaneous coronary intervention, transcatheter aortic valve implantation",

author = "Giuliano Costa and Thomas Pilgrim and \{Amat Santos\}, \{Ignacio J.\} and \{de Backer\}, Ole and Won-Keun Kim and Ribeiro, \{Henrique Barbosa\} and Francesco Saia and Matjaz Bunc and Didier Tchetche and Philippe Garot and Ribichini, \{Flavio Luciano\} and Darren Mylotte and Francesco Burzotta and Yusuke Watanabe and \{de Marco\}, Federico and Tullio Tesorio and Tobias Rheude and Marco Tocci and Anna Franzone and Roberto Valvo and Mikko Savontaus and Hendrik Wienemann and Italo Porto and Caterina Gandolfo and Alessandro Iadanza and Bortone, \{Alessandro Santo\} and Markus Mach and Azeem Latib and Luigi Biasco and Maurizio Taramasso and \{REVASC-TAVI Registry\} and Marco Zimarino and Daijiro Tomii and Philippe Nuyens and Lars Sondergaard and Camara, \{Sergio F.\} and Tullio Palmerini and Mateusz Orzalkiewicz and Klemen Steblovnik and Bastien Degrelle and Alexandre Gautier and \{del Sole\}, \{Paolo Alberto\} and Andrea Mainardi and Michele Pighi and Mattia Lunardi and Hideyuki Kawashima and Enrico Criscione and Vincenzo Cesario and Fausto Biancari and Federico Zanin and Michael Joner and Giovanni Esposito and Matti Adam and Eberhard Grube and Stephan Baldus and \{de Marzo\}, Vincenzo and Elisa Piredda and Stefano Cannata and Fortunato Iacovelli and Martin Andreas and Valentina Frittitta and Elena Dipietro and Claudia Reddavid and Orazio Strazzieri and Silvia Motta and Domenico Angellotti and Carmelo Sgroi and Faraj Kargoli and Corrado Tamburino and Marco Barbanti",

note = "Publisher Copyright: {\textcopyright} 2022 American Heart Association, Inc.",

year = "2022",

month = dec,

day = "1",

doi = "10.1161/CIRCINTERVENTIONS.122.012417",

language = "English",

volume = "15",

pages = "E012417",

journal = "Circulation: Cardiovascular Interventions",

issn = "1941-7640",

publisher = "Lippincott Williams and Wilkins",

number = "12",

}

TY - JOUR

T1 - Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation

AU - Costa, Giuliano

AU - Pilgrim, Thomas

AU - Amat Santos, Ignacio J.

AU - de Backer, Ole

AU - Kim, Won-Keun

AU - Ribeiro, Henrique Barbosa

AU - Saia, Francesco

AU - Bunc, Matjaz

AU - Tchetche, Didier

AU - Garot, Philippe

AU - Ribichini, Flavio Luciano

AU - Mylotte, Darren

AU - Burzotta, Francesco

AU - Watanabe, Yusuke

AU - de Marco, Federico

AU - Tesorio, Tullio

AU - Rheude, Tobias

AU - Tocci, Marco

AU - Franzone, Anna

AU - Valvo, Roberto

AU - Savontaus, Mikko

AU - Wienemann, Hendrik

AU - Porto, Italo

AU - Gandolfo, Caterina

AU - Iadanza, Alessandro

AU - Bortone, Alessandro Santo

AU - Mach, Markus

AU - Latib, Azeem

AU - Biasco, Luigi

AU - Taramasso, Maurizio

AU - REVASC-TAVI Registry

AU - Zimarino, Marco

AU - Tomii, Daijiro

AU - Nuyens, Philippe

AU - Sondergaard, Lars

AU - Camara, Sergio F.

AU - Palmerini, Tullio

AU - Orzalkiewicz, Mateusz

AU - Steblovnik, Klemen

AU - Degrelle, Bastien

AU - Gautier, Alexandre

AU - del Sole, Paolo Alberto

AU - Mainardi, Andrea

AU - Pighi, Michele

AU - Lunardi, Mattia

AU - Kawashima, Hideyuki

AU - Criscione, Enrico

AU - Cesario, Vincenzo

AU - Biancari, Fausto

AU - Zanin, Federico

AU - Joner, Michael

AU - Esposito, Giovanni

AU - Adam, Matti

AU - Grube, Eberhard

AU - Baldus, Stephan

AU - de Marzo, Vincenzo

AU - Piredda, Elisa

AU - Cannata, Stefano

AU - Iacovelli, Fortunato

AU - Andreas, Martin

AU - Frittitta, Valentina

AU - Dipietro, Elena

AU - Reddavid, Claudia

AU - Strazzieri, Orazio

AU - Motta, Silvia

AU - Angellotti, Domenico

AU - Sgroi, Carmelo

AU - Kargoli, Faraj

AU - Tamburino, Corrado

AU - Barbanti, Marco

PY - 2022/12/1

Y1 - 2022/12/1

N2 - BACKGROUND: The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. METHODS: The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. RESULTS: Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio‚ 0.88 [95% CI, 0.66–1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio‚ 0.97 [95% CI, 0.76–1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). CONCLUSIONS: The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.

AB - BACKGROUND: The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. METHODS: The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. RESULTS: Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio‚ 0.88 [95% CI, 0.66–1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio‚ 0.97 [95% CI, 0.76–1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). CONCLUSIONS: The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.

KW - coronary artery disease

KW - myocardial revascularization

KW - outcome

KW - percutaneous coronary intervention

KW - transcatheter aortic valve implantation

UR - https://www.scopus.com/pages/publications/85144124190

U2 - 10.1161/CIRCINTERVENTIONS.122.012417

DO - 10.1161/CIRCINTERVENTIONS.122.012417

M3 - Article

C2 - 36538579

SN - 1941-7640

VL - 15

SP - E012417

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 12

ER -

Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation

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Keywords

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