Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2021; 13(8): 361-371
Published online Aug 26, 2021. doi: 10.4330/wjc.v13.i8.361
Role of coronary angiogram before transcatheter aortic valve implantation
Benjamin Beska, Divya Manoharan, Ashfaq Mohammed, Rajiv Das, Richard Edwards, Azfar Zaman, Mohammad Alkhalil
Benjamin Beska, Divya Manoharan, Ashfaq Mohammed, Rajiv Das, Richard Edwards, Azfar Zaman, Mohammad Alkhalil, Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
Author contributions: Alkhalil M was conceptualized; Mohammed A, Das R, Edwards R, Zaman A, and Alkhalil M were investigated; Beska B, Manoharan D, and Alkhalil M are responsible for the methodology and project management; Alkhalil M carried out data processing and software formal analysis; Beska B, Manoharan D, Mohammed A, Das R, Edwards R, Zaman A, and Alkhalil M are responsible for the resources; Beska B and Alkhalil M were responsible for the preparation of the first draft; all authors have written reviews and edited.
Institutional review board statement: The current analysis was based on a clinical audit on the work up of transcatheter aortic valve implantation with focus on invasive coronary angiography. Ethical review was waived as part of the audit process and all collected data were anonymised during the analysis
Informed consent statement: The informed consent statement was waived.
Conflict-of-interest statement: Nothing to disclose.
Data sharing statement: Data are available from the corresponding authors on a reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammad Alkhalil, DPhil, MRCP, Doctor, Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne NE7 7DN, United Kingdom. mak-83@hotmail.com
Received: March 21, 2021
Peer-review started: March 21, 2021
First decision: May 5, 2021
Revised: May 26, 2021
Accepted: July 16, 2021
Article in press: July 16, 2021
Published online: August 26, 2021
Processing time: 154 Days and 22.5 Hours
Abstract
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

Keywords: Transcatheter aortic valve implantation; Angiogram; Revascularisation; Coronary angiogram

Core Tip: Previous studies showed that pre-transcatheter aortic valve implantation coronary revascularisation was not associated with improved outcomes, challenging the clinical value of routine coronary angiogram (CA). A selective approach for performing CA tailored to patient clinical need was developed. In 348 patients, the primary endpoint of all-cause mortality, myocardial infraction, repeat CA, and re-admission with heart failure was comparable between patients who underwent CA vs no CA (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 myocardial infarction (P = 0.007). The clinical value of routine CA should be challenged in future randomised trials.