1. Incidence, Clinical Characteristics, and Impact of Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement.
- Author
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Vilalta V, Asmarats L, Ferreira-Neto AN, Maes F, de Freitas Campos Guimarães L, Couture T, Paradis JM, Mohammadi S, Dumont E, Kalavrouziotis D, Delarochellière R, and Rodés-Cabau J
- Subjects
- Acute Coronary Syndrome diagnostic imaging, Acute Coronary Syndrome mortality, Acute Coronary Syndrome therapy, Aged, Aged, 80 and over, Angina, Unstable diagnostic imaging, Angina, Unstable mortality, Angina, Unstable therapy, Female, Hospital Mortality, Humans, Incidence, Male, Non-ST Elevated Myocardial Infarction diagnostic imaging, Non-ST Elevated Myocardial Infarction mortality, Non-ST Elevated Myocardial Infarction therapy, Patient Readmission, Percutaneous Coronary Intervention, Quebec epidemiology, Risk Assessment, Risk Factors, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction therapy, Time Factors, Treatment Outcome, Acute Coronary Syndrome epidemiology, Angina, Unstable epidemiology, Non-ST Elevated Myocardial Infarction epidemiology, ST Elevation Myocardial Infarction epidemiology, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
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., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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