831 Functionally Significant Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation is Associated With Increased Mortality.

Background: Coronary artery disease (CAD) is common in patients undergoing transcatheter aortic valve replacement (TAVR). Clinical outcomes following TAVR are determined by anatomical CAD complexity as determined by SYNTAX score (SS). However it remains unclear on whether the functional significance of lesions can also predict outcome. In this study we sought to compare the prognostic utility of two angiographic scoring systems in patients undergoing TAVR. Method(s): CAD physiological significance was determined by DILEMMA scoring (DS); a validated angiographic tool that strongly correlates with fractional flow reserve. Both DS and SS were classified using predefined values. The primary endpoint was 1-year all-cause mortality, with secondary endpoint of 30-day major adverse cardiac and cerebrovascular events (MACCE). Result(s): Mean age was 83.9+/-0.5yrs (n=229, 55.0% female) and all-cause mortality was 11.8%. Presence of CAD (>=30% stenosis in any vessel) was not associated with outcome (HR=1.08, p=0.84). However, both SS>9 (20.8% vs 9.4%, HR 2.34, p=0.03) and DS>2 (18.4% vs 8.5%, HR=2.28, p=0.03) were associated with increased mortality at 1-year and also predictive of 30-day MACCE (both p<0.05). After multivariate adjustment, the only independent predictors of 1-year mortality were DS>2 (HR=2.29, p=0.04), LVEF<50% (HR 2.66, p=0.04) and COPD (HR 2.43, p=0.04). Conclusion(s): Our results demonstrate that SS and DS both predict 12-month mortality and 30-day MACCE following TAVR. However, only DS remains independently predictive after multivariate adjustment, implying that the functional significance of CAD may be more relevant than anatomical complexity when planning pre-TAVR revascularisation.Copyright © 2020