title: The Rationale for Performance of Coronary Angiography and Stenting Before Transcatheter Aortic Valve Replacement: From the Interventional Section Leadership Council of the American College of Cardiology.
abstract: Transcatheter aortic valve replacement (TAVR) is an effective, nonsurgical treatment option for patients with severe aortic stenosis. The optimal treatment strategy for treating concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. Nevertheless, it is standard practice in the United States to perform coronary angiography and percutaneous coronary intervention for significant CAD at least 1 month before TAVR. All existing clinical trials were designed using this strategy. Therefore, it is wrong to extrapolate current American College of Cardiology/American Heart Association Appropriate Use Criteria against invasive procedures in asymptomatic patients to the TAVR population when evaluating the quality of care by cardiologists or hospitals. In this statement from the Interventional Section Leadership Council of the ACC, it is recommended that percutaneous coronary intervention should be considered in all patients with significant proximal coronary stenosis in major coronary arteries before TAVR, even though the indication is not covered in current guidelines.
authors.affiliation: Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Stephen
authors.initials: S
authors.lastname: Ramee
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.affiliation: Emory University/Atlanta VA Medical Center, Atlanta, Georgia.
authors.forename: Gautam
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Piana
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Rab
authors.affiliation: Rush Medical College, Chicago, Illinois. Electronic address: lloydklein@comcast.net.
authors.forename: Lloyd W
authors.initials: LW
authors.lastname: Klein
mesh_terms: D026683:Advisory Committees; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000066491:Clinical Decision-Making; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007857:Leadership; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012955:Societies, Medical; D015607:Stents; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects; D016896:Treatment Outcome
keywords: TAVR; appropriateness; coronary stenting