Background and Aims In transcatheter aortic valve replacement (TAVR) recipients, the optimal management of concomitant chronic obstructive coronary artery disease (CAD) remains unknown. Some advocate for pre-TAVR percutaneous coronary intervention, while others manage it expectantly. The aim of this study was to assess the impact of varying degrees and extent of untreated chronic obstructive CAD on TAVR and longer-term outcomes. Methods The authors conducted a retrospective cohort study of TAVR recipients from January 2015 to November 2021, separating patients into stable non-obstructive or varying degrees of obstructive CAD. The major outcomes of interest were procedural all-cause mortality and complications, major adverse cardiovascular events, and post-TAVR unplanned coronary revascularization. Results Of the 1911 patients meeting inclusion, 75%, 6%, 10%, and 9% had non-obstructive, intermediate-risk, high-risk, and extreme-risk CAD, respectively. Procedural complication rates overall were low (death 0.4%, shock 0.1%, extracorporeal membrane oxygenation 0.1%), with no difference across groups. At a median follow-up of 21 months, rates of acute coronary syndrome and unplanned coronary revascularization were 0.7% and 0.5%, respectively, in the non-obstructive population, rising in incidence with increasing severity of CAD (P < .001 for acute coronary syndrome/unplanned coronary revascularization). Multivariable analysis did not yield a significantly greater risk of all-cause mortality or major adverse cardiovascular events across groups. One-year acute coronary syndrome and unplanned coronary revascularization rates in time-to-event analyses were significantly greater in the non-obstructive (98%) vs. obstructive (94%) subsets (Plog-rank< .001). Conclusions Transcatheter aortic valve replacement can be performed safely in patients with untreated chronic obstructive CAD, without portending higher procedural complication rates and with relatively low rates of unplanned coronary revascularization and acute coronary syndrome at 1 year.

中文翻译：

---

未经治疗的慢性阻塞性冠状动脉疾病对经导管主动脉瓣置换术后结果的影响

背景和目的 在经导管主动脉瓣置换术 (TAVR) 接受者中，伴随慢性阻塞性冠状动脉疾病 (CAD) 的最佳治疗方法仍然未知。一些人主张进行 TAVR 前经皮冠状动脉介入治疗，而另一些人则抱着期待的态度进行治疗。本研究的目的是评估不同程度和程度的未经治疗的慢性阻塞性 CAD 对 TAVR 和长期结果的影响。方法 作者对 2015 年 1 月至 2021 年 11 月 TAVR 接受者进行了回顾性队列研究，将患者分为稳定的非梗阻性或不同程度的梗阻性 CAD。感兴趣的主要结局是手术全因死亡率和并发症、主要不良心血管事件以及 TAVR 后计划外冠状动脉血运重建。结果 在纳入的 1911 名患者中，分别有 75%、6%、10% 和 9% 患有非梗阻性、中危、高危和极高危 CAD。总体手术并发症发生率较低（死亡 0.4%、休克 0.1%、体外膜肺氧合 0.1%），各组之间没有差异。在中位随访 21 个月时，非阻塞性​​人群中急性冠状动脉综合征和非计划冠状动脉血运重建的发生率分别为 0.7% 和 0.5%，其发生率随着 CAD 严重程度的增加而上升（对于急性冠状动脉综合征/计划外冠状动脉血运重建）。多变量分析并未得出各组间全因死亡率或主要不良心血管事件的风险显着增加。在事件发生时间分析中，一年急性冠状动脉综合征和非计划冠状动脉血运重建率在非阻塞性亚组 (98%) 中显着高于阻塞性亚组 (94%) (Plog-rank < .001)。结论 未经治疗的慢性阻塞性 CAD 患者可以安全地进行经导管主动脉瓣置换术，不会出现较高的手术并发症发生率，并且 1 年时非计划冠状动脉血运重建和急性冠状动脉综合征的发生率相对较低。