Incidence, clinical characteristics, and impact of acute coronary syndrome following transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) has become a well-established therapy for patients with severe, symptomatic aortic stenosis who are at intermediate-to-high surgical risk over last decade. Aortic stenosis and coronary artery disease (CAD) have similar risk factors and pathogenic pathways, and 40% to 75% of TAVR patients had significant CAD. In patients with severe CAD following aortic valve replacement, current recommendations advocate coronary revascularization (Class IIa, Level of Evidence: C). Patients who underwent TAVR at our facility on consecutive days between May 2007 and November 2017 were included. Patients were observed for one, six, and twelve months, and then once a year after that. A total of 779 individuals were included in the study (, with 68% having a history of CAD. At the end of a median follow-up of 25 months, 78 patients (10%) had at least one episode of ACS, with half of the occurrences occurring within the first year after TAVR. Clinical presentation was type 2 non–ST-segment elevation myocardial infarction, unstable angina, type 1 non–ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction. Male sex and nontransfemoral approach had an independent association with ACS. In-hospital death rate at the time of the ACS episode was 3.8%. At a median follow-up of 21 months post-ACS, all-cause and cardiovascular death rates were 37.3% and 25.3%, respectively. After a median follow-up of 25 months, about one-tenth of patients who underwent TAVR were readmitted for an ACS. Male sex, prior CAD, and nontransfemoral method all predicted ACS independently. ACS was linked to a significant rate of midterm mortality. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.