Impact of coronary artery disease severity assessed with the SYNTAX score on outcomes following transcatheter aortic valve replacement

Jean Michel Paradis, Jonathon M. White, Philippe Généreux, Marina Urena, Darshan Doshi, Tamim Nazif, Rebecca Hahn, Isaac George, Omar Khalique, Kishore Harjai, Laura Lasalle, Benoit M. Labbé, Robert DeLarochelliére, Daniel Doyle, Éric Dumont, Siamak Mohammadi, Martin B. Leon, Josep Rodés-Cabau, Susheel Kodali

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25 Citations (Scopus)

Abstract

Background-The influence of coronary artery disease (CAD) on clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) is still controversial. We sought to evaluate the impact of CAD severity as measured by the SYNTAX score (SS) on patients undergoing TAVR. Methods and Results-A total of 377 patients who underwent TAVR in 2 high-volume centers in North America were included in our retrospective analysis. A blinded angiographic core laboratory calculated the SS on all available coronary angiograms with the use of quantitative coronary analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0) (2) low SS (SS between 1 and 22) (3) intermediate SS (SS between 23 and 32) and (4) high SS (SS =33). Patients who had undergone percutaneous coronary intervention within 6 months prior to TAVR were separated into 2 categories based on their residual SS (< 8 and =8). Patients with previous coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low CABG SS and (2) high CABG SS. The primary end point was a composite of all-cause mortality, myocardial infarction, and stroke. At 30 days and 1 year, both the presence and the severity of CAD had no impact on the rate of the combined primary end point and on all-cause mortality, cardiovascular mortality, and myocardial infarction. Patients with less complete revascularization (residual SS =8 versus residual SS < 8 and low CABG SS versus high CABG SS, had similar rates of the combined primary end point, all-cause mortality, cardiovascular mortality, MI, and stroke, at both 30 days and 1 year. Conclusions-In our core laboratory-validated study, neither the severity of CAD nor completeness of revascularization after percutaneous coronary intervention or CABG were associated with clinical outcomes after TAVR, at both 30 days and 1 year.

Original languageEnglish (US)
Article numbere005070
JournalJournal of the American Heart Association
Volume6
Issue number2
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Coronary Artery Bypass
Coronary Artery Disease
Mortality
Percutaneous Coronary Intervention
Stroke
Myocardial Infarction
North America
Transcatheter Aortic Valve Replacement
Angiography

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Paradis, Jean Michel ; White, Jonathon M. ; Généreux, Philippe ; Urena, Marina ; Doshi, Darshan ; Nazif, Tamim ; Hahn, Rebecca ; George, Isaac ; Khalique, Omar ; Harjai, Kishore ; Lasalle, Laura ; Labbé, Benoit M. ; DeLarochelliére, Robert ; Doyle, Daniel ; Dumont, Éric ; Mohammadi, Siamak ; Leon, Martin B. ; Rodés-Cabau, Josep ; Kodali, Susheel. / Impact of coronary artery disease severity assessed with the SYNTAX score on outcomes following transcatheter aortic valve replacement. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 2.
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title = "Impact of coronary artery disease severity assessed with the SYNTAX score on outcomes following transcatheter aortic valve replacement",
abstract = "Background-The influence of coronary artery disease (CAD) on clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) is still controversial. We sought to evaluate the impact of CAD severity as measured by the SYNTAX score (SS) on patients undergoing TAVR. Methods and Results-A total of 377 patients who underwent TAVR in 2 high-volume centers in North America were included in our retrospective analysis. A blinded angiographic core laboratory calculated the SS on all available coronary angiograms with the use of quantitative coronary analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0) (2) low SS (SS between 1 and 22) (3) intermediate SS (SS between 23 and 32) and (4) high SS (SS =33). Patients who had undergone percutaneous coronary intervention within 6 months prior to TAVR were separated into 2 categories based on their residual SS (< 8 and =8). Patients with previous coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low CABG SS and (2) high CABG SS. The primary end point was a composite of all-cause mortality, myocardial infarction, and stroke. At 30 days and 1 year, both the presence and the severity of CAD had no impact on the rate of the combined primary end point and on all-cause mortality, cardiovascular mortality, and myocardial infarction. Patients with less complete revascularization (residual SS =8 versus residual SS < 8 and low CABG SS versus high CABG SS, had similar rates of the combined primary end point, all-cause mortality, cardiovascular mortality, MI, and stroke, at both 30 days and 1 year. Conclusions-In our core laboratory-validated study, neither the severity of CAD nor completeness of revascularization after percutaneous coronary intervention or CABG were associated with clinical outcomes after TAVR, at both 30 days and 1 year.",
author = "Paradis, {Jean Michel} and White, {Jonathon M.} and Philippe G{\'e}n{\'e}reux and Marina Urena and Darshan Doshi and Tamim Nazif and Rebecca Hahn and Isaac George and Omar Khalique and Kishore Harjai and Laura Lasalle and Labb{\'e}, {Benoit M.} and Robert DeLarochelli{\'e}re and Daniel Doyle and {\'E}ric Dumont and Siamak Mohammadi and Leon, {Martin B.} and Josep Rod{\'e}s-Cabau and Susheel Kodali",
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Paradis, JM, White, JM, Généreux, P, Urena, M, Doshi, D, Nazif, T, Hahn, R, George, I, Khalique, O, Harjai, K, Lasalle, L, Labbé, BM, DeLarochelliére, R, Doyle, D, Dumont, É, Mohammadi, S, Leon, MB, Rodés-Cabau, J & Kodali, S 2017, 'Impact of coronary artery disease severity assessed with the SYNTAX score on outcomes following transcatheter aortic valve replacement', Journal of the American Heart Association, vol. 6, no. 2, e005070. https://doi.org/10.1161/JAHA.116.005070

Impact of coronary artery disease severity assessed with the SYNTAX score on outcomes following transcatheter aortic valve replacement. / Paradis, Jean Michel; White, Jonathon M.; Généreux, Philippe; Urena, Marina; Doshi, Darshan; Nazif, Tamim; Hahn, Rebecca; George, Isaac; Khalique, Omar; Harjai, Kishore; Lasalle, Laura; Labbé, Benoit M.; DeLarochelliére, Robert; Doyle, Daniel; Dumont, Éric; Mohammadi, Siamak; Leon, Martin B.; Rodés-Cabau, Josep; Kodali, Susheel.

In: Journal of the American Heart Association, Vol. 6, No. 2, e005070, 01.01.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of coronary artery disease severity assessed with the SYNTAX score on outcomes following transcatheter aortic valve replacement

AU - Paradis, Jean Michel

AU - White, Jonathon M.

AU - Généreux, Philippe

AU - Urena, Marina

AU - Doshi, Darshan

AU - Nazif, Tamim

AU - Hahn, Rebecca

AU - George, Isaac

AU - Khalique, Omar

AU - Harjai, Kishore

AU - Lasalle, Laura

AU - Labbé, Benoit M.

AU - DeLarochelliére, Robert

AU - Doyle, Daniel

AU - Dumont, Éric

AU - Mohammadi, Siamak

AU - Leon, Martin B.

AU - Rodés-Cabau, Josep

AU - Kodali, Susheel

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background-The influence of coronary artery disease (CAD) on clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) is still controversial. We sought to evaluate the impact of CAD severity as measured by the SYNTAX score (SS) on patients undergoing TAVR. Methods and Results-A total of 377 patients who underwent TAVR in 2 high-volume centers in North America were included in our retrospective analysis. A blinded angiographic core laboratory calculated the SS on all available coronary angiograms with the use of quantitative coronary analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0) (2) low SS (SS between 1 and 22) (3) intermediate SS (SS between 23 and 32) and (4) high SS (SS =33). Patients who had undergone percutaneous coronary intervention within 6 months prior to TAVR were separated into 2 categories based on their residual SS (< 8 and =8). Patients with previous coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low CABG SS and (2) high CABG SS. The primary end point was a composite of all-cause mortality, myocardial infarction, and stroke. At 30 days and 1 year, both the presence and the severity of CAD had no impact on the rate of the combined primary end point and on all-cause mortality, cardiovascular mortality, and myocardial infarction. Patients with less complete revascularization (residual SS =8 versus residual SS < 8 and low CABG SS versus high CABG SS, had similar rates of the combined primary end point, all-cause mortality, cardiovascular mortality, MI, and stroke, at both 30 days and 1 year. Conclusions-In our core laboratory-validated study, neither the severity of CAD nor completeness of revascularization after percutaneous coronary intervention or CABG were associated with clinical outcomes after TAVR, at both 30 days and 1 year.

AB - Background-The influence of coronary artery disease (CAD) on clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) is still controversial. We sought to evaluate the impact of CAD severity as measured by the SYNTAX score (SS) on patients undergoing TAVR. Methods and Results-A total of 377 patients who underwent TAVR in 2 high-volume centers in North America were included in our retrospective analysis. A blinded angiographic core laboratory calculated the SS on all available coronary angiograms with the use of quantitative coronary analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0) (2) low SS (SS between 1 and 22) (3) intermediate SS (SS between 23 and 32) and (4) high SS (SS =33). Patients who had undergone percutaneous coronary intervention within 6 months prior to TAVR were separated into 2 categories based on their residual SS (< 8 and =8). Patients with previous coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low CABG SS and (2) high CABG SS. The primary end point was a composite of all-cause mortality, myocardial infarction, and stroke. At 30 days and 1 year, both the presence and the severity of CAD had no impact on the rate of the combined primary end point and on all-cause mortality, cardiovascular mortality, and myocardial infarction. Patients with less complete revascularization (residual SS =8 versus residual SS < 8 and low CABG SS versus high CABG SS, had similar rates of the combined primary end point, all-cause mortality, cardiovascular mortality, MI, and stroke, at both 30 days and 1 year. Conclusions-In our core laboratory-validated study, neither the severity of CAD nor completeness of revascularization after percutaneous coronary intervention or CABG were associated with clinical outcomes after TAVR, at both 30 days and 1 year.

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U2 - 10.1161/JAHA.116.005070

DO - 10.1161/JAHA.116.005070

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