title: Impact of Coronary Artery Disease Burden on 12-Month Mortality of Patients After Transcatheter Aortic Valve Implantation.
abstract: OBJECTIVE
  The aim of the study was to compare 12-month mortality rate of patients with and without complete coronary revascularization before transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  There are limited data on the impact of coronary artery disease burden in patients with severe aortic stenosis undergoing TAVI.
  
  
  METHODS
  One hundred and one consecutive patients undergoing TAVI were enrolled. Of them 16 (15.8%) had an incomplete coronary revascularization. The primary endpoint was 12-month all-cause mortality.
  
  
  RESULTS
  Twelve-month all-cause mortality was higher in patients with incomplete coronary revascularization than in patients with complete coronary revascularization or without significant lesions (75.0% vs 7.1%; P < 0.001). Importantly, incomplete coronary revascularization was an independent predictor of higher mortality rate after 12 months (hazard ratio (HR) for incomplete coronary revascularization 10.86, 95% CI 3.72-31.73; P < 0.001; HR for a history of stroke/TIA 3.93, 95% confidence interval (CI) 1.39-11.07; P < 0.001; HR for blood transfusion 2.84 95% CI (1.06-7.63); P = 0.039). In 9 of 16 (56.3%) patients, incomplete revascularization was related to the presence of chronic total occlusions (CTO). Patients with CTO had an increased mortality rate after 12 months (55.6% vs 14.1%; P = 0.008) as compared to patients without the CTO.
  
  
  CONCLUSIONS
  Incomplete coronary revascularization and a history of stroke or TIA may be independent predictors of all-cause mortality in patients undergoing TAVI. However, further studies are recommended to confirm the results, especially in terms of the impact of CTO presence on long-term mortality after TAVI.
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Kleczynski
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Bagienski
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Rzeszutko
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Sorysz
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Trebacz
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Sobczynski
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Tomala
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Gackowski
authors.affiliation: Institute of Cardiology, Krakow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D017281:Cost of Illness; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009026:Mortality; D011044:Poland / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome