title: Impact of Coronary Artery Disease Severity Assessed With the SYNTAX Score on Outcomes Following Transcatheter Aortic Valve Replacement.
abstract: The influence of coronary artery disease (CAD) on clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) is still controversial. We sought to evaluate the impact of CAD severity as measured by the SYNTAX score (SS) on patients undergoing TAVR.
  
  
  
  A total of 377 patients who underwent TAVR in 2 high-volume centers in North America were included in our retrospective analysis. A blinded angiographic core laboratory calculated the SS on all available coronary angiograms with the use of quantitative coronary analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0); (2) low SS (SS between 1 and 22); (3) intermediate SS (SS between 23 and 32); and (4) high SS (SS ≥33). Patients who had undergone percutaneous coronary intervention within 6 months prior to TAVR were separated into 2 categories based on their residual SS (<8 and ≥8). Patients with previous coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low CABG SS and (2) high CABG SS. The primary end point was a composite of all-cause mortality, myocardial infarction, and stroke. At 30 days and 1 year, both the presence and the severity of CAD had no impact on the rate of the combined primary end point and on all-cause mortality, cardiovascular mortality, and myocardial infarction. Patients with less complete revascularization (residual SS ≥8 versus residual SS <8 and low CABG SS versus high CABG SS, had similar rates of the combined primary end point, all-cause mortality, cardiovascular mortality, MI, and stroke, at both 30 days and 1 year.
  
  
  
  In our core laboratory-validated study, neither the severity of CAD nor completeness of revascularization after percutaneous coronary intervention or CABG were associated with clinical outcomes after TAVR, at both 30 days and 1 year.
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.|Cardiovascular Research Foundation, New-York, NY.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Paradis
authors.affiliation: Columbia University Medical Center, New-York, NY.
authors.forename: Jonathon M
authors.initials: JM
authors.lastname: White
authors.affiliation: Cardiovascular Research Foundation, New-York, NY.|Hopital du Sacre-Coeur de Montreal, Montreal, Quebec Canada.|Gagnon Cardiovascular Institute Morristown Medical Center, Morristown, New Jersey.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: Columbia University Medical Center, New-York, NY.
authors.forename: Darshan
authors.initials: D
authors.lastname: Doshi
authors.affiliation: Cardiovascular Research Foundation, New-York, NY.|Columbia University Medical Center, New-York, NY.
authors.forename: Tamim
authors.initials: T
authors.lastname: Nazif
authors.affiliation: Cardiovascular Research Foundation, New-York, NY.|Columbia University Medical Center, New-York, NY.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hahn
authors.affiliation: Columbia University Medical Center, New-York, NY.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
authors.affiliation: Columbia University Medical Center, New-York, NY.
authors.forename: Omar
authors.initials: O
authors.lastname: Khalique
authors.affiliation: Columbia University Medical Center, New-York, NY.
authors.forename: Kishore
authors.initials: K
authors.lastname: Harjai
authors.affiliation: Cardiovascular Research Foundation, New-York, NY.
authors.forename: Laura
authors.initials: L
authors.lastname: Lasalle
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Benoit M
authors.initials: BM
authors.lastname: Labbé
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Éric
authors.initials: É
authors.lastname: Dumont
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.affiliation: Cardiovascular Research Foundation, New-York, NY.|Columbia University Medical Center, New-York, NY.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: Cardiovascular Research Foundation, New-York, NY sk2427@cumc.columbia.edu.|Columbia University Medical Center, New-York, NY.
authors.forename: Susheel
authors.initials: S
authors.lastname: Kodali
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009656:North America / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: SYNTAX score; aortic stenosis; coronary artery disease; transcatheter aortic valve replacement