title: Impact of coronary artery disease on indications for transcatheter aortic valve implantation and on procedural outcomes.
abstract: OBJECTIVE
  To describe the characteristics of coronary artery disease (CAD) in high-risk patients with aortic stenosis (AS), and its impact on indications for transcatheter aortic valve implantation (TAVI), and on outcomes.
  
  
  RESULTS
  Of 240 patients referred for TAVI, 230 had documented CAD status. Mean age was 81.5±8 years. Hundred and forty-four (63%) had CAD. Compared to patients with no CAD, those with CAD had a higher risk of mortality (EuroSCORE: 31±18%, vs. 23±11%, p=0.004). Overall, 145 patients (63%) underwent TAVI, 31 (13%) surgery, and 54 (24%) medical treatment. No patient was denied intervention because of the CAD. CAD led to re-orientate one patient (0.4%) towards surgery. PCI was performed before TAVI in 11 (7%). Survival rates were respectively 90% and 85% in the CAD and non-CAD groups (p=0.37) at 30 days, and 76.4±5.4% and 70.6±6.8% (p=0.28) at 1-year. At follow-up, functional status was similar in both groups and no further revascularisation was needed.
  
  
  CONCLUSIONS
  In high-risk patients referred for TAVI, CAD is frequent and associated with worse baseline characteristics. It has a limited impact on indications for TAVI. It seldom requires revascularisation and does not preclude satisfactory outcomes after TAVI.
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Gautier
authors.forename: Marion
authors.initials: M
authors.lastname: Pepin
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Dilly
authors.forename: David
authors.initials: D
authors.lastname: Attias
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010297:Paris; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome