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Role of coronary angiogram before transcatheter aortic valve implantation

Lookup NU author(s): Dr Ben Beska, Dr Ashfaq Mohammed, Dr Rajiv Das, Dr Richard Edwards, Professor Azfar Zaman, Dr Mohammad Alkhalil


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┬ęThe Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.BACKGROUND Coexistent coronary artery disease is commonly seen in patients undergoing transcatheter aortic valve implantation (TAVI). Previous studies showed that pre-TAVI coronary revascularisation was not associated with improved outcomes, challenging the clinical value of routine coronary angiogram (CA). AIM To assess whether a selective approach to perform pre-TAVI CA is safe and feasible. METHODS This was a retrospective non-randomised single-centre analysis of consecutive patients undergoing TAVI. A selective approach for performing CA tailored to patient clinical need was developed. Clinical outcomes were compared based on whether patients underwent CA. The primary endpoint was a composite of all-cause mortality, myocardial infraction, repeat CA, and re-admission with heart failure. RESULTS Of 348 patients (average age 81 ┬▒ 7 and 57% male) were included with a median follow up of 19 (9-31) mo. One hundred and fifty-four (44%) patients, underwent CA before TAVI procedure. Patients who underwent CA were more likely to have previous myocardial infarction (MI) and previous percutaneous revascularisation. The primary endpoint was comparable between the two group (22.6% vs 22.2%; hazard ratio 1.05, 95%CI: 0.67-1.64, P = 0.82). Patients who had CA were less likely to be readmitted with heart failure (P = 0.022), but more likely to have repeat CA (P = 0.002) and MI (P = 0.007). In those who underwent CA, the presence of flow limiting lesions did not affect the incidence of primary endpoint, or its components, except for increased rate of repeat CA. CONCLUSION Selective CA is a feasible and safe approach. The clinical value of routine CA should be challenged in future randomised trials

Publication metadata

Author(s): Beska B, Manoharan D, Mohammed A, Das R, Edwards R, Zaman A, Alkhalil M

Publication type: Article

Publication status: Published

Journal: World Journal of Cardiology

Year: 2021

Volume: 13

Issue: 8

Pages: 361-371

Online publication date: 26/08/2021

Acceptance date: 16/07/2021

ISSN (electronic): 1949-8462

Publisher: Baishideng Publishing Group Co


DOI: 10.4330/wjc.v13.i8.361


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