1. Natural History of Coronary Atherosclerosis in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: The Role of Quantitative Flow Ratio.
- Author
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Colaiori I, Paolucci L, Mangiacapra F, Barbato E, Ussia GP, Grigioni F, Demola P, Vitolo M, Benatti G, Vignali L, Gabbieri D, Magnavacchi P, Sgura FA, Boriani G, and Guiducci V
- Subjects
- Humans, Male, Female, Retrospective Studies, Aged, Aged, 80 and over, Risk Factors, Treatment Outcome, Italy, Time Factors, Coronary Circulation, Aortic Valve surgery, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Disease Progression, Risk Assessment, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis mortality, Transcatheter Aortic Valve Replacement mortality, Transcatheter Aortic Valve Replacement adverse effects, Severity of Illness Index, Coronary Artery Disease mortality, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Coronary Artery Disease physiopathology, Coronary Artery Disease complications, Coronary Angiography, Predictive Value of Tests
- Abstract
Background: The prognostic impact of functionally significant coronary artery disease, as assessed with quantitative flow ratio (QFR), in patients with severe aortic stenosis treated with transcatheter aortic valve replacement is unknown., Methods: This is a retrospective study with blind analysis of angiographic data, enrolling consecutive patients with severe aortic stenosis treated with transcatheter aortic valve replacement at 4 Italian centers. None of the patients enrolled received pre-transcatheter aortic valve replacement or concomitant coronary revascularization, either for the absence of significant coronary stenoses or by clinical decision. Visual estimation of diameter stenosis and QFR analysis were performed in all coronary arteries. The end point was all-cause mortality at a 3-year follow-up., Results: A total of 318 patients were enrolled. At visual estimation, 140 patients (44%) presented a diameter stenosis ≥50% in at least 1 coronary artery, whereas 78 patients (24.5%) had at least 1 vessel with QFR <0.80 and, therefore, included in the positive QFR group. Overall, 69 (21.7%) patients died during the follow-up. In the Kaplan-Meier analysis, patients with positive QFR experienced significantly higher rates of death during follow-up compared with those without (51.1% versus 12.1%; P <0.001), whereas no significant difference was evident in terms of death between patients with or without significant coronary artery disease according to angiographic evaluation (24.3% versus 19.7%; P =0.244). In a multivariate regression model, positive QFR was an independent predictor of all-cause death during follow-up (hazard ratio, 5.31 [95% CI, 3.21-8.76])., Conclusions: Coronary QFR can predict mortality in patients with severe aortic stenosis treated with transcatheter aortic valve replacement without revascularization., Competing Interests: None.
- Published
- 2024
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