Author + information
- Received June 18, 2018
- Revision received September 3, 2018
- Accepted September 4, 2018
- Published online December 17, 2018.
- Victoria Vilalta, MD∗,
- Lluis Asmarats, MD∗,
- Alfredo Nunes Ferreira-Neto, MD,
- Frederic Maes, MD,
- Leonardo de Freitas Campos Guimarães, MD,
- Thomas Couture, MS,
- Jean-Michel Paradis, MD,
- Siamak Mohammadi, MD,
- Eric Dumont, MD,
- Dimitri Kalavrouziotis, MD,
- Robert Delarochellière, MD and
- Josep Rodés-Cabau, MD∗ ()
- ↵∗Address for correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, Quebec City G1V 4GS, Quebec, Canada.
Objectives The authors sought to assess the incidence, predictors, management, and prognosis of acute coronary syndrome (ACS) following TAVR.
Background About one-half of the patients undergoing transcatheter aortic valve replacement (TAVR) have concurrent coronary artery disease (CAD). However, the occurrence and clinical impact of coronary events following TAVR remain largely unknown.
Methods Consecutive patients undergoing TAVR in our institution between May 2007 and November 2017 were included. Patients were followed at 1, 6, and 12 months, and yearly thereafter. ACS was diagnosed and classified according to the Third Universal Definition of Myocardial Infarction.
Results A total of 779 patients (mean age 79 ± 9 years, 52% male, mean STS: 6.8 ± 5.1%) were included, 68% of which had a history of CAD. At a median follow-up of 25 (interquartile range: 10 to 44) months, 78 patients (10%) presented at least 1 episode of ACS, with one-half of the events occurring within the year following TAVR. Clinical presentation was type 2 non–ST-segment elevation myocardial infarction (35.9%), unstable angina (34.6%), type 1 non–ST-segment elevation myocardial infarction (28.2%), and ST-segment elevation myocardial infarction (1.3%). Male sex (hazard ratio [HR]: 2.19; 95% confidence interval [CI]: 1.36 to 3.54; p = 0.001), prior CAD (HR: 2.78; 95% CI: 1.50 to 5.18; p = 0.001), and nontransfemoral approach (HR: 1.71; 95% CI: 1.04 to 2.75; p = 0.035) were independently associated with ACS. Coronary angiography was performed in 53 (67.9%) patients with ACS, and 30 of them (56.6%) underwent percutaneous coronary intervention. In-hospital death rate at the time of the ACS episode was 3.8%. At a median follow-up of 21 (interquartile range: 8 to 34) months post-ACS, all-cause and cardiovascular death rates were 37.3% and 25.3%, respectively.
Conclusions Approximately one-tenth of patients undergoing TAVR were readmitted for an ACS after a median follow-up of 25 months. Male sex, prior CAD, and nontransfemoral approach were independent predictors of ACS. ACS was associated with high midterm mortality.
- acute coronary syndrome(s)
- myocardial infarction
- transcatheter aortic valve replacement
- unstable angina
↵∗ Drs. Vilalta and Asmarats contributed equally to this work.
Dr. Asmarats was supported by a grant from the Fundacion Alfonso Martin Escudero (Madrid, Spain). Dr. Rodés-Cabau holds the Canadian Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions. Dr. Rodés-Cabau has received institutional research grants from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 18, 2018.
- Revision received September 3, 2018.
- Accepted September 4, 2018.
- 2018 American College of Cardiology Foundation
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