Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement
Por:
Faroux, L, Munoz-Garcia, E, Serra, V, Alperi, A, Nombela-Franco, L, Fischer, Q, Veiga, G, Donaint, P, Asmarats, L, Vilalta, V, Chamandi, C, Regueiro, A, Gutierrez, E, Munoz-Garcia, A, del Blanco, BG, Bach-Oller, M, Moris, C, Armijo, G, Urena, M, Fradejas-Sastre, V, Metz, D, Castillo, P, Fernandez-Nofrerias, E, Sabate, M, Tamargo, M, del Val, D, Couture, T, Rodes-Cabau, J
Publicada:
1 feb 2020
Resumen:
Background:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
Filiaciones:
Faroux, L:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Munoz-Garcia, E:
Hosp Univ Virgen Victoria, Malaga, Spain
Serra, V:
Hosp Univ Vall dHebron, Barcelona, Spain
Alperi, A:
Hosp Univ Cent Asturias, Oviedo, Spain
Nombela-Franco, L:
Hosp Univ Clin San Carlos, Cardiovasc Inst, Madrid, Spain
Fischer, Q:
Hop Xavier Bichat, AP HP, Paris, France
Veiga, G:
Hosp Marques Valdecilla, Santander, Spain
Donaint, P:
Reims Univ Hosp, Reims, France
Asmarats, L:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Vilalta, V:
Hosp Germans Trias & Pujol Badalona, Badalona, Spain
Chamandi, C:
Hop Georges Pompidou, Paris, France
Regueiro, A:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Hosp Clin, Inst Clin Cardiovasc, Barcelona, Spain
Gutierrez, E:
Inst Invest Sanitaria Gregorio Maranon, Madrid, Spain
Munoz-Garcia, A:
Hosp Univ Virgen Victoria, Malaga, Spain
del Blanco, BG:
Hosp Univ Vall dHebron, Barcelona, Spain
Bach-Oller, M:
Hosp Univ Vall dHebron, Barcelona, Spain
Moris, C:
Hosp Univ Cent Asturias, Oviedo, Spain
Armijo, G:
Hosp Univ Clin San Carlos, Cardiovasc Inst, Madrid, Spain
Urena, M:
Hop Xavier Bichat, AP HP, Paris, France
Fradejas-Sastre, V:
Hosp Marques Valdecilla, Santander, Spain
Metz, D:
Reims Univ Hosp, Reims, France
Castillo, P:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Fernandez-Nofrerias, E:
Hosp Germans Trias & Pujol Badalona, Badalona, Spain
Sabate, M:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Hosp Clin, Inst Clin Cardiovasc, Barcelona, Spain
Tamargo, M:
Inst Invest Sanitaria Gregorio Maranon, Madrid, Spain
del Val, D:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Couture, T:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Rodes-Cabau, J:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
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