|
|||||
|
|
Feasibility of Coronary Access in Patients With Acute Coronary Syndrome and Previous TAVR |
|
| Authors: | Won-Keun Kim Costanza Pellegrini Sebastian Ludwig Helge Möllmann Florian Leuschner Raj Makkar Jürgen Leick Ignacio J Amat-Santos Oliver Dörr Philipp Breitbart Victor A Jimenez Diaz Maciej Dabrowski Tanja Rudolph Pablo Avanzas Jatinderjit Kaur Stefan Toggweiler Sebastian Kerber Patrick Ranosch Jan-Malte Sinning |
| Institution: | 1. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany;2. DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany;3. Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany;4. Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany;5. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany;6. Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany;7. Department of Cardiology, St. Johannes Hospital, Dortmund, Germany;8. Department of Medicine III, University of Heidelberg, German Centre for Cardiovascular Research (DZHK), Heidelberg, Germany;9. Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California, USA;10. Department of Cardiology, Barmherzige Brüder Hospital, Trier, Germany;11. CIBERCV, University Clinic Hospital of Valladolid, Valladolid, Spain;12. Division of Cardiology & Angiology II, University Heart Center Freiburg–Bad Krozingen, Bad Krozingen, Germany;13. Hospital Alvaro Cunqueiro, Interventional Cardiology Unit, Cardiology Department, University Hospital of Vigo, Vigo, Spain;14. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland;15. Herz- und Diabeteszentrum NRW, Department of General and Interventional Cardiology and Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany;p. Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain;q. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain;r. Department of Medicine, University of Oviedo, Oviedo, Spain;s. Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany;t. Heart Center Lucerne, Lucerner Kantonsspital, Lucerne, Switzerland;u. Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt an der Saale, Germany;v. Humanitas Clinical and Research Center, IRCCS, Milan, Italy;w. Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), UKSH University Clinical Center Schleswig-Holstein, Kiel, Germany;x. DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany;y. Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, St. Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada;z. Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel;11. Division of Cardiology, A.O.U. Policlinico “G. Rodolico – San Marco,” Catania, Italy;22. Interventional Cardiology, Department of Cardiacthoracic and Vascular Science, Ospedale dell’Angelo, Venice, Italy;33. Department of Cardiology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland;44. National Cardiovascular Institute, Bratislava, Slovak Republic;55. University Hospital Bonn, Heart Center Bonn, Bonn, Germany |
| Abstract: | ObjectivesThe aim of this study was to characterize the feasibility of coronary angiography (CA) and percutaneous coronary intervention (PCI) in acute settings among patients who have undergone transcatheter aortic valve replacement (TAVR).BackgroundImpaired coronary access after TAVR may be challenging and particularly in acute settings could have deleterious consequences.MethodsIn this international registry, data from patients with prior TAVR requiring urgent or emergent CA were retrospectively collected. A total of 449 patients from 25 sites with acute coronary syndromes (89.1%) and other acute cardiovascular situations (10.9%) were included.ResultsSuccess rates were high for CA of the right coronary artery (98.3%) and left coronary artery (99.3%) and were higher among patients with short stent-frame prostheses (SFPs) than in those with long SFPs for CA of the right coronary artery (99.6% vs 95.9%; P = 0.005) but not for CA of the left coronary artery (99.7% vs 98.7%; P = 0.24). PCI of native coronary arteries was successful in 91.4% of cases and independent of valve type (short SFP 90.4% vs long SFP 93.4%; P = 0.44). Guide engagement failed in 6 patients, of whom 3 underwent emergent coronary artery bypass grafting and another 3 died in the hospital. Among patients requiring revascularization of native vessels, independent predictors of 30-day all-cause mortality were prior diabetes, cardiogenic shock, and failed PCI but not valve type or success of coronary engagement.ConclusionsCA or PCI after TAVR in acute settings is usually successful, but selective coronary engagement may be more challenging in the presence of long SFPs. Among patients requiring PCI, prior diabetes, cardiogenic shock, and failed PCI were predictors of early mortality. |
| Keywords: | coronary access myocardial infarction PCI TAVR ACS"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"acute coronary syndrome(s) CA"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"coronary angiography CABG"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"coronary artery bypass grafting CI"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"confidence interval IQR"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"interquartile range LCA"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"left coronary artery ORadj:"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"adjusted odds ratio PCI"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"percutaneous coronary intervention RCA"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"right coronary artery SFP"} {"#name":"keyword" "$":{"id":"kwrd0125"} "$$":[{"#name":"text" "_":"stent-frame prosthesis STEMI"} {"#name":"keyword" "$":{"id":"kwrd0135"} "$$":[{"#name":"text" "_":"ST-segment elevation myocardial infarction TAVR"} {"#name":"keyword" "$":{"id":"kwrd0145"} "$$":[{"#name":"text" "_":"transcatheter aortic valve replacement |
| 本文献已被 ScienceDirect 等数据库收录！ | |