Abstract 15926: Impact of Extent of Coronary Revascularization on Mortality After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Background:The concurrent incidence of aortic stenosis (AS) and coronary artery disease is estimated to be 50 - 60%. Coronary intervention in patients with severe CAD leads to improved outcomes, however impact of completeness of revascularization remains unknown.Objective:The primary objective was to evaluate the prognostic impact of completeness of coronary revascularization on all-cause mortality in patients undergoing TAVR.Methods:Literature search was performed using MEDLINE, EMBASE, Google Scholar and Scopus databases. Three sets of comparisons were performed: 1) Patients with no CAD versus CAD patients with high residual syntax score(rSS) >10, 2) Patients with no CAD versus CAD patients with low rSS ?10, 3) CAD Patients with low rSS versus CAD patients with high rSS. Data on all-cause mortality was extracted digitally form the Kaplan-Meier curves. Hazard ratios were calculated using Palmer method and meta-analysis was performed using random effects model. Heterogeneity was calculated using Q statistic and I2. The main summary estimate was random effects hazard Ratio (HR) with 95% confidence intervals (CIs).Results:Eight studies including 4,237 patients were included to look for prognostic effect of revascularization completeness before TAVR using rSS. Follow up period ranged from 0.7 to 4.8 years. Our results showed that CAD Patients with high rSS (>10) had increased risk of all-cause mortality as compared to patients with no CAD at longest follow up (HR=1.40, 95% CI: 1.10 - 1.78, I2=38.826). Whereas, there was no difference in patients with CAD and low rSS (?10) versus no CAD (HR=1.12, 95% CI: 0.85 - 1.60, I2=57.632). Interestingly, comparison of CAD patients with low rSS and high rSS also revealed no difference in all-cause mortality (HR = 1.05, 95% CI: 0.76 - 1.44,I2=58.88).Conclusions:Completeness of coronary revascularization with PCI or CABG in patients undergoing TAVR for AS did not significantly impact long-term all-cause mortality.