Title

Outcomes of Transcatheter Aortic Valve Replacement With and Without Index Chronic Total Occlusion of Coronary Artery: A Propensity Matched Analysis

Authors

Mohammed Faisaluddin, Department of Internal Medicine, Rochester General Hospital, Rochester, New York.
Yasar Sattar, Department of Cardiology, West Virginia University, Morgantown, West Virginia.
Nouraldeen Manasrah, Department of Internal Medicine, Wayne State University, Detroit Medical Center, Sinai Grace Hospital, Detroit, Michigan.
Sandeep Banga, Division of Cardiology, Michigan State University/Sparrow Hospital, Lansing, Michigan.
Asmaa Ahmed, Department of Internal Medicine, Rochester General Hospital, Rochester, New York.
Mishita Goel, Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan.
Amro Taha, Department of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois.
Sardar Muhammad Alamzaib, Department of Cardiology, Marshall University, Huntington, West Virginia.
Hafeez Ul Virk, Department of Cardiology, Adena Regional Medical Center, Chillicothe, Ohio.
Mahboob Alam, Department of Cardiology, Baylor College of Medicine, Houston, Texas.
M Chadi Alraies, Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan.
Sourbha S. Dani, Department of Cardiology, Lahey Clinic, Boston, Massachusetts.
Sabeeda Kadavath, Department of Cardiology, St Bernard's Healthcare, Arkansas.
Akram Kawsara, Department of Cardiology, West Virginia University, Morgantown, West Virginia.
Islam Y. Elgendy, Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
Ramesh Daggubati, Department of Cardiology, West Virginia University, Morgantown, West Virginia.

Department

Internal Medicine

Document Type

Article

Publication Title

The American Journal of Cardiology

Abstract

Transcatheter aortic valve replacement (TAVR) utilization is increasing, along with procedural success. Coronary angiography is frequently performed before the TAVR procedure for coronary artery disease workup. Chronic total occlusion (CTO) of the coronary artery shares common risk factors with aortic stenosis and could be challenging, especially in terms of procedural safety. The outcomes of TAVR among patients with concomitant CTO are not extensively studied. We analyzed the National Inpatient Sample database between October 2015 and December 2020 to evaluate the clinical characteristics, procedural safety, and outcomes among patients who underwent TAVR who had concomitant CTO lesions. A total of 304,330 TAVRs were performed between 2015 and 2020, 5,235 of which (1.72%) were in patients with TAVR-CTO and 299,095 (98.28%) in those with TAVR-no CTO. After propensity matching, there was no difference in the odds of in-hospital mortality (adjusted odds ratio [aOR] 1.28, 95% confidence interval [CI] 0.94 to 1.75, p = 0.11). However, TAVR-CTO was associated with an increased incidence of acute myocardial infarction (aOR 1.27, 95% CI 1.05 to 1.53, p = 0.01), cardiac arrest (aOR, 2.60, 95% CI 1.64 to 4.11, p < 0.0001), and need for mechanical circulatory support (aOR 2.6, 95% CI 1.88 to 3.59, p < 0.0001). There was no difference in the incidence of stroke, major bleeding, complete heart block, or requirement for permanent pacemaker between the 2 groups. However, the TAVR-CTO cohort had a slightly greater length of stay and total hospitalization cost. TAVR is a relatively safe procedure among those with concomitant CTO lesions; however, it is associated with a greater incidence of acute myocardial infarction, cardiac arrest, and requirement for mechanical circulatory support.

First Page

405

Last Page

412

DOI

10.1016/j.amjcard.2023.07.069

Volume

204

Publication Date

10-1-2023

Medical Subject Headings

Humans; Coronary Vessels (diagnostic imaging, surgery); Transcatheter Aortic Valve Replacement; Myocardial Infarction; Stroke; Heart Arrest

PubMed ID

37598538

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