title: Coronary Artery Disease and Symptomatic Severe Aortic Valve Stenosis: Clinical Outcomes after Transcatheter Aortic Valve Implantation.
abstract: BACKGROUND
  The impact of coronary artery disease (CAD) on outcomes after transcatheter aortic valve implantation (TAVI) has not been clarified. Furthermore, less is known about the indication and strategy of revascularization in these high risk patients.
  
  
  OBJECTIVE
  This study sought to determine the prevalence and prognostic impact of CAD in patients undergoing TAVI, and to assess the safety and feasibility of percutaneous coronary intervention (PCI) before TAVI.
  
  
  METHODS
  Patients with severe aortic stenosis (AS) undergoing TAVI were included into a prospective single center registry from 2007 to 2012. Clinical outcomes were compared between patients with and without CAD. In some patients with CAD, it was decided to perform elective PCI before TAVI after decision by the Heart team. The primary endpoints were 30-day and 2-year all-cause mortality.
  
  
  RESULTS
  A total of 91 consecutive patients with mean age of 79 ± 9 years (52% men) underwent TAVI with a median follow-up duration of 16 months (interquartile range of 27.6 months). CAD was present on 46 patients (51%). At 30-day, the incidences of death were similar between CAD and non-CAD patients (9 and 5%, p = 0.44), but at 2 years were 50% in CAD patients and 24% in non-CAD patients [crude hazard ratio with CAD, 2.2; 95% confidence interval (CI), 1.1-4.6; p = 0.04]. Adjusting for age, gender, left ventricular ejection fraction, and glomerular filtration rate, the hazard of death was 2.6-fold higher in patients with CAD (95% CI, 1.1-6.0; p = 0.03). Elective PCI before TAVI was performed in 13 patients (28% of CAD patients). There were no more adverse events in patients who underwent TAVI + PCI when compared with those who underwent isolated TAVI.
  
  
  CONCLUSIONS
  In severe symptomatic AS who underwent TAVI, CAD is frequent and adversely impacts long-term outcomes, but not procedure outcomes. In selected patients, PCI before TAVI appears to be feasible and safe.
authors.affiliation: Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mancio
authors.affiliation: Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal ; Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto University , Porto , Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fontes-Carvalho
authors.affiliation: Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal.
authors.forename: Marco
authors.initials: M
authors.lastname: Oliveira
authors.affiliation: Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal.
authors.forename: Daniel
authors.initials: D
authors.lastname: Caeiro
authors.affiliation: Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Braga
authors.affiliation: Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal ; Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto University , Porto , Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.affiliation: Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal.
authors.forename: Vasco Gama
authors.initials: VG
authors.lastname: Ribeiro
keywords: aortic valve stenosis; coronary disease; percutaneous coronary angioplasty intervention; prognosis; transcatheter aortic valve implantation