title: Effect of coronary artery disease severity and revascularization completeness on 2-year clinical outcomes in patients undergoing transcatether aortic valve replacement.
abstract: OBJECTIVE
  To evaluate the effect of coronary artery disease (CAD) severity and completeness of revascularization on clinical outcomes following transcatheter aortic valve replacement (TAVR) using the SYNTAX score (SS), clinical SYNTAX score (cSS), and residual SYNTAX score (rSS).
  
  
  RESULTS
  We studied 287 consecutive patients undergoing TAVR at our institution. Patients were classified as having CAD or no CAD and coronary patients were stratified according to SS and cSS. The completeness of revascularization was stratified using the rSS. We compared the 2-year outcomes according to SS/cSS/rSS. Forty-nine patients (17.1%) had CAD and sustained a higher rate of the primary endpoint at 2 years (28.3 vs. 16.1%, P=0.026). Stratified by CAD severity, the difference was driven by the high-severity groups (75.0 vs. 16.1%, P=0.002 for SS>22 and 41.2 vs. 16.1%, P=0.001 for cSS>63). Low-severity CAD patients did not have worse outcomes versus no CAD. When evaluating the effect of revascularization, patients with a rSS less than 8 did not have worse outcomes versus patients who did not have CAD.
  
  
  CONCLUSIONS
  In patients undergoing TAVR, it is the severity of CAD (as assessed by the SS/cSS) that is associated with worse prognosis and not the mere presence of CAD. More complete revascularization attenuates the effect of CAD on clinical outcomes.
authors.affiliation: Departments of aCardiology bInternal Medicine E, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Witberg
authors.forename: Ifat
authors.initials: I
authors.lastname: Lavi
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Harari
authors.forename: Tzipora
authors.initials: T
authors.lastname: Shohat
authors.forename: Katia
authors.initials: K
authors.lastname: Orvin
authors.forename: Pablo
authors.initials: P
authors.lastname: Codner
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D015607:Stents; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome