Advertisement

Concomitant Coronary Artery Disease and Aortic Stenosis

  • Carolina Espejo
  • Gabriela Tirado-Conte
  • Luis Nombela-Franco
  • Pilar Jimenez-Quevedo
Chapter

Abstract

Coronary artery disease and aortic stenosis frequently coexist, and share several risk factors and underlying pathogenetic pathways. Although current guidelines recommend coronary revascularization of all significant stenosis in patients undergoing surgical aortic valve replacement, this approach remains matter of debate in patients undergoing transcatheter aortic valve implantation (TAVI). In the TAVI scenario, the clinical decision is based on the patient’s clinical condition, extent of coronary artery disease, and the amount of myocardium at risk.

This chapter discusses, all available information referring to coronary disease in patients with severe aortic stenosis susceptible to TAVI, focusing on its prevalence, its clinical implications, management, and the antiplatelet therapy after stent implantation, will be discussed.

Keywords

Transcatheter aortic valve implantation Coronary artery disease Percutaneous coronary intervention Stent Bleeding 

References

  1. 1.
    Leon MB, Smith CR, Mack MJ, et al. PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–20.Google Scholar
  2. 2.
    Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H, Chetcuti S, Gleason T, Heiser J, Lange R, Merhi W, Oh JK, Olsen PS, Piazza N, Williams M, Windecker S, Yakubov SJ, Grube E, Makkar R, Lee JS, Conte J, Vang E, Nguyen H, Chang Y, Mugglin AS, Serruys PW, Kappetein AP, SURTAVI Investigators. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2017;376:1321–31.CrossRefGoogle Scholar
  3. 3.
    Ramsdale DR, Bennett DH, Bray CL, et al. Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study. Eur Heart J. 1984;5:716–26.CrossRefGoogle Scholar
  4. 4.
    Vandeplas A, Willems JL, Piessens J, de Geest H. Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis. Am J Cardiol. 1988;62:117–20.CrossRefGoogle Scholar
  5. 5.
    Mohler ER, Sheridan MJ, Nichols R, Harvey WP, Waller BF. Development and progression of aortic valve stenosis: atherosclerosis risk factors--a causal relationship? A clinical morphologic study. Clin Cardiol. 1991;14(12):995–9.CrossRefGoogle Scholar
  6. 6.
    Beach JM, Mihaljevic T, Svensson LG, Rajeswaran J, Marwick T, Griffin B, Johnston DR, Sabik JF 3rd, Blackstone EH. Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol. 2013;61:837–48.CrossRefGoogle Scholar
  7. 7.
    Leon MB, Kodali S, Williams M, Oz M, Smith C, Stewart A, Schwartz A, Collins M, Moses JW. Transcatheter aortic valve replacement in patients with critical aortic stenosis: rationale, device descriptions, early clinical experiences, and perspectives. Semin Thorac Cardiovasc Surg. 2006;18(2):165–74.CrossRefGoogle Scholar
  8. 8.
    Alexander KP, Anstrom KJ, Muhlbaier LH, Grosswald RD, Smith PK, Jones RH, Peterson ED. Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network. J Am Coll Cardiol. 2000;35(3):731–8.CrossRefGoogle Scholar
  9. 9.
    Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Juni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541–619.CrossRefGoogle Scholar
  10. 10.
    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–279.CrossRefGoogle Scholar
  11. 11.
    Khawaja MZ, Wang D, Pocock S, Redwood SR, Thomas MR. The percutaneous coronary intervention prior to transcatheter aortic valve implantation (ACTIVATION) trial: study protocol for a randomized controlled trial. Trials. 2014;15:300.CrossRefGoogle Scholar
  12. 12.
    Steadman CD, Jerosch-Herold M, Grundy B, Rafelt S, Ng LL, Squire IB, Samani NJ, McCann GP. Determinants and functional significance of myocardial perfusion reserve in severe aortic stenosis. JACC Cardiovasc Imaging. 2012;5:182–9.CrossRefGoogle Scholar
  13. 13.
    Tonino PAL, De Bruyne B, Pijls NHJ, Siebert U, Ikeno F, van’t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360(3):213–24.CrossRefGoogle Scholar
  14. 14.
    Pesarini G, Scarsini R, Zivelonghi C, Piccoli A, Gambaro A, Gottin L, Rossi A, Ferrero V, Vassanelli C, Ribichini F. Functional assessment of coronary artery disease in patients undergoing transcatheter aortic valve implantation: influence of pressure overload on the evaluation of lesions severity. Circ Cardiovasc Interv 2016;9(11). pii: e004088.Google Scholar
  15. 15.
    Scarsini R, Pesarini G, Zivelonghi C, Piccoli A, Ferrero V, Lunardi M, Gottin L, Zanetti C, Faggian G, Ribichini F. Physiologic evaluation of coronary lesions using instantaneous wave-free ratio (iFR) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. EuroIntervention. 2018;13:1512–9.CrossRefGoogle Scholar
  16. 16.
    Stefanini GG, Stortecky S, Cao D, Rat-Wirtzler J, O’Sullivan CJ, Gloekler S, Buellesfeld L, Khattab AA, Nietlispach F, Pilgrim T, Huber C, Carrel T, Meier B, Jüni P, Wenaweser P, Windecker S. Coronary artery disease severity and aortic. stenosis: clinical outcomes according to SYNTAX score in patients undergoing. transcatheter aortic valve implantation. Eur Heart J. 2014;35(37):2530–40.CrossRefGoogle Scholar
  17. 17.
    Ryan N, Nombela-Franco L, Jiménez-Quevedo P, Biagioni C, Salinas P, Aldazábal A, Cerrato E, Gonzalo N, Del Trigo M, Núñez-Gil I, Fernández-Ortiz A, Macaya C, Escaned J. The value of the SYNTAX Score II in predicting clinical outcomes in patients undergoing transcatheter aortic valve implantation. Rev Esp Cardiol (Engl Ed). 2018;71(8):628–37.CrossRefGoogle Scholar
  18. 18.
    D’Ascenzo F, Conrotto F, Giordana F, Moretti C, D’Amico M, Salizzoni S, Omedè P, La Torre M, Thomas M, Khawaja Z, Hildick-Smith D, Ussia G, Barbanti M, Tamburino C, Webb J, Schnabel RB, Seiffert M, Wilde S, Treede H, Gasparetto V, Napodano M, Tarantini G, Presbitero P, Mennuni M, Rossi ML, Gasparini M, Biondi Zoccai G, Lupo M, Rinaldi M, Gaita F, Marra S. Mid-term prognostic value of coronary artery disease in patients undergoing transcatheter aortic valve implantation: a meta-analysis of adjusted observational results. Int J Cardiol. 2013;168(3):2528–32.CrossRefGoogle Scholar
  19. 19.
    Pasic M, Dreysse S, Unbehaun A, Buz S, Drews T, Klein C, et al. Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg. 2012;14:463–8.CrossRefGoogle Scholar
  20. 20.
    Dewey TM, Brown DL, Herbert MA, Culica D, Smith CR, Leon MB, et al. Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation. Ann Thorac Surg. 2010;89:758–67.CrossRefGoogle Scholar
  21. 21.
    Abdel-Wahab M, Zahn R, Horack M, Gerckens U, Schuler G, Sievert H, Naber C, Voehringer M, Schäfer U, Senges J, Richardt G. Transcatheter aortic valve implantation in patients with and without concomitant coronary artery disease: comparison of characteristics and early outcome in the German multicenter TAVI registry. Clin Res Cardiol. 2012;101(12):973–81.CrossRefGoogle Scholar
  22. 22.
    Ussia GP, Barbanti M, Colombo A, Tarantini G, Petronio AS, Ettori F, Ramondo A, Santoro G, Klugmann S, Bedogni F, Antoniucci D, Maisano F, Marzocchi A, Poli A, De Carlo M, Fiorina C, De Marco F, Napodano M, Violini R, Bortone AS, Tamburino C, CoreValve Italian Registry Investigators. Impact of coronary artery disease in elderly patients undergoing transcatheter aortic valve implantation: insight from the Italian CoreValve Registry. Int J Cardiol. 2013;167(3):943–50.CrossRefGoogle Scholar
  23. 23.
    Penkalla A, Pasic M, Drews T, Buz S, Dreysse S, Kukucka M, Mladenow A, Hetzer R, Unbehaun A. Transcatheter aortic valve implantation combined with elective coronary artery stenting: a simultaneous approach. Eur J Cardiothorac Surg. 2015;47(6):1083–9.CrossRefGoogle Scholar
  24. 24.
    Pilgrim T, Stortecky S, Luterbacher F, Windecker S, Wenaweser P. Transcatheter aortic valve implantation and bleeding: incidence, predictors and prognosis. J Thromb Thrombolysis. 2013;35(4):456–62.CrossRefGoogle Scholar
  25. 25.
    Griese DP, Reents W, Tóth A, Kerber S, Diegeler A, Babin-Ebell J. Concomitant coronary intervention is associated with poorer early and late clinical outcomes in selected elderly patients receiving transcatheter aortic valve implantation. Eur J Cardiothorac Surg. 2014;46(1):e1–7.CrossRefGoogle Scholar
  26. 26.
    Czerwińska-Jelonkiewicz K, Witkowski A, Dąbrowski M, Banaszewski M, Księżycka-Majczyńska E, Chmielak Z, Kuśmierski K, Hryniewiecki T, Demkow M, Orłowska-Baranowska E, Stępińska J. Antithrombotic therapy - predictor of early and long-term bleeding complications after transcatheter aortic valve implantation. Arch Med Sci. 2013;9(6):1062–70.CrossRefGoogle Scholar
  27. 27.
    Rodés-Cabau J, Dauerman HL, Cohen MG, Mehran R, Small EM, Smyth SS, Costa MA, Mega JL, O’Donoghue ML, Ohman EM, Becker RC. Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events. J Am Coll Cardiol. 2013;62(25):2349–59.CrossRefGoogle Scholar
  28. 28.
    Ranucci M, Ballotta A, Kunkl A, De Benedetti D, Kandil H, Conti D, Mollichelli N, Bossone E, Mehta RH. Influence of the timing of cardiac catheterization and the amount of contrast media on acute renal failure after cardiac surgery. Am J Cardiol. 2008;101(8):1112–8.CrossRefGoogle Scholar
  29. 29.
    Gasparetto V, Fraccaro C, Tarantini G, Buja P, D’Onofrio A, Yzeiraj E, et al. Safety and effectiveness of a selective strategy for coronary artery revascularization before transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2013;81:376–83.CrossRefGoogle Scholar
  30. 30.
    Wenaweser P, Pilgrim T, Guerios E, Stortecky S, Huber C, Khattab AA, et al. Impact of coronary artery disease and percutaneous coronary intervention on outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. EuroIntervention. 2011;7:541–8.CrossRefGoogle Scholar
  31. 31.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD, American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):2438–88.Google Scholar
  32. 32.
    Hassell ME, Hildick-Smith D, Durand E, Kikkert WJ, Wiegerinck EM, Stabile E, Ussia GP, Sharma S, Baan J Jr, Eltchaninoff H, Rubino P, Barbanti M, Tamburino C, Poliacikova P, Blanchard D, Piek JJ, Delewi R. Antiplatelet therapy following transcatheter aortic valve implantation. Heart. 2015;101(14):1118–25.CrossRefGoogle Scholar
  33. 33.
    Généreux P, Head SJ, Van Mieghem NM, et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol. 2012;59:2317–26.CrossRefGoogle Scholar
  34. 34.
    Borz B, Durand E, Godin M, Tron C, Canville A, Litzler PY, Bessou JP, Cribier A, Eltchaninoff H. Incidence, predictors and impact of bleeding after transcatheter aortic valve implantation using the balloon-expandable Edwards prosthesis. Heart. 2013;99(12):860–5.CrossRefGoogle Scholar
  35. 35.
    Rodés-Cabau J, Masson JB, Welsh RC, Garcia Del Blanco B, Pelletier M, Webb JG, Al-Qoofi F, Généreux P, Maluenda G, Thoenes M, Paradis JM, Chamandi C, Serra V, Dumont E, Côté M. Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with a balloon-expandable valve: the ARTE (aspirin versus aspirin + clopidogrel following transcatheter aortic valve implantation) randomized clinical trial. JACC Cardiovasc Interv. 2017;10(13):1357–65.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Carolina Espejo
    • 1
  • Gabriela Tirado-Conte
    • 1
  • Luis Nombela-Franco
    • 1
  • Pilar Jimenez-Quevedo
    • 1
  1. 1.Interventional Cardiology DepartmentHospital Clinico San CarlosMadridSpain

Personalised recommendations