title: Routine Screening of Coronary Artery Disease With Computed Tomographic Coronary Angiography in Place of Invasive Coronary Angiography in Patients Undergoing Transcatheter Aortic Valve Replacement.
abstract: BACKGROUND
  Coronary artery disease (CAD) screening is required before transcatheter aortic valve implantation (TAVR). Although invasive coronary angiography (CA) remains the gold standard for CAD assessment, computed tomographic CA (CTCA) could be a safe and effective noninvasive alternative for CAD screening in patients undergoing TAVR.
  
  
  RESULTS
  From November 2007 to May 2013, all patients undergoing TAVR at our institution were included in the study cohort. CTCA was used as first-line imaging tool for CAD screening. Invasive CA was performed when any of the following were present: coronary anatomy at CTCA was not evaluable and presence of significant CAD at CTCA. The primary objective was to compare major adverse cardiovascular and cerebrovascular events at 30 days and 1 year between patients who performed CTCA as only screening test and those who performed CTCA and invasive CA. Of 491 patients treated with TAVR, 375 (76.3%) performed only CTCA, whereas 116 (21.7%) underwent also CA. No differences were present in crude major adverse cardiovascular and cerebrovascular event rates at 30 days and 1 year between the 2 groups. After multivariable adjustment, CTCA performed alone was not associated with higher risk of MACE at 1 year of follow-up (hazard ratio, 0.89; 95% confidence interval, 0.49-1.60; P=0.69).
  
  
  CONCLUSIONS
  CTCA performed as a routine noninvasive imaging tool in patients undergoing TAVR seems safe and effective allowing, with a single test, acquisition of information on aortic annulus anatomy, peripheral access sites, and evaluation of coronary anatomy.
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.). chieffo.alaide@hsr.it.
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Gennaro
authors.initials: G
authors.lastname: Giustino
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Pietro
authors.initials: P
authors.lastname: Spagnolo
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Vasileios F
authors.initials: VF
authors.lastname: Panoulas
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Chiara
authors.initials: C
authors.lastname: Gerli
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Annalisa
authors.initials: A
authors.lastname: Franco
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Manuela
authors.initials: M
authors.lastname: Giglio
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Micaela
authors.initials: M
authors.lastname: Cioni
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Paolo Guido
authors.initials: PG
authors.lastname: Camici
authors.affiliation: From the Interventional Cardiology Unit and Cardiothoracic Department, San Raffaele Scientific Institute (A. Chieffo, G.G., M.M., A.L., F.F., E.A., C.G., A.F., M.C., O.A., A. Colombo), Center for Cardiovascular Prevention (P.S., M.G.), Vita-Salute University (P.G.C.), San Raffaele Scientific Institute, Milan, Italy; and Department of Cardiology, Imperial College London, National Heart and Lung Institute, London, United Kingdom (V.F.P.).
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement
keywords: aortic valve stenosis; coronary angiography; coronary artery disease; follow-up studies; transcatheter aortic valve replacement