title: Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether coronary artery disease (CAD) severity exerts a gradient of risk in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
  
  
  RESULTS
  A total of 445 patients with severe AS undergoing TAVI were included into a prospective registry between 2007 and 2012. The preoperative SYNTAX score (SS) was determined from baseline coronary angiograms. In case of revascularization prior to TAVI, residual SS (rSS) was also determined. Clinical outcomes were compared between patients without CAD (n = 158), patients with low SS (0-22, n = 207), and patients with high SS (SS > 22, n = 80). The pre-specified primary endpoint was the composite of cardiovascular death, stroke, or myocardial infarction (MI). At 1 year, CAD severity was associated with higher rates of the primary endpoint (no CAD: 12.5%, low SS: 16.1%, high SS: 29.6%; P = 0.016). This was driven by differences in cardiovascular mortality (no CAD: 8.6%, low SS: 13.6%, high SS: 20.4%; P = 0.029), whereas the risk of stroke (no CAD: 5.1%, low SS: 3.3%, high SS: 6.7%; P = 0.79) and MI (no CAD: 1.5%, low SS: 1.1%, high SS: 4.0%; P = 0.54) was similar across the three groups. Patients with high SS received less complete revascularization as indicated by a higher rSS (21.2 ± 12.0 vs. 4.0 ± 4.4, P < 0.001) compared with patients with low SS. High rSS tertile (> 14) was associated with higher rates of the primary endpoint at 1 year (no CAD:12.5%, low rSS: 16.5%, high rSS: 26.3%, P = 0.043).
  
  
  CONCLUSIONS
  Severity of CAD appears to be associated with impaired clinical outcomes at 1 year after TAVI. Patients with SS > 22 receive less complete revascularization and have a higher risk of cardiovascular death, stroke, or MI than patients without CAD or low SS.
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Giulio G
authors.initials: GG
authors.lastname: Stefanini
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Davide
authors.initials: D
authors.lastname: Cao
authors.affiliation: CTU Bern, Department of Clinical Research, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Julie
authors.initials: J
authors.lastname: Rat-Wirtzler
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Crochan J
authors.initials: CJ
authors.lastname: O'Sullivan
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Lutz
authors.initials: L
authors.lastname: Buellesfeld
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.affiliation: Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.affiliation: Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: CTU Bern, Department of Clinical Research, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland peter.wenaweser@insel.ch.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality / Q000473:pathology; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: Aortic stenosis; Coronary artery disease; SYNTAX score; Transcatheter aortic valve implantation