ACS and revascularization after TAVR: New data on a high-risk scenario
Patients who undergo transcatheter aortic valve replacement (TAVR) face a heightened risk of death if readmitted within 90 days due to acute coronary syndrome (ACS), according to new findings published in the American Journal of Cardiology.[1] Revascularization was not common among these patients, but it was still deemed necessary in certain cases.
“ACS refers to a spectrum of coronary artery disease (CAD), including unstable angina and myocardial infarction, and is one of the most common causes of death in the United States,” wrote first author Takuya Ogami, MD, a specialist with the department of cardiothoracic surgery at the University of Pittsburgh Medical Center, and colleagues. “ACS requires prompt intervention and, often, cardiac catheter intervention for diagnosis and treatment. However, cardiac catheter intervention strategy may become complex after TAVR because both a transcatheter heart valve and an unresected native valve may disturb access to a coronary artery. In contrast, intervention for CAD before TAVR also raises a concern for a hemorrhagic risk because of antiplatelet therapy and vascular complications.”
To learn more about the timing of CAD interventions in TAVR patients, Ogami et al. explored data from more than 44,000 patients who were readmitted to the hospital within 90 days of TAVR from 2012 to 2018. All data came from the National Readmission Database.
Overall, 3.2% of patients readmitted within 90 days of TAVR were there for ACS-related reasons. These patients were more likely to be men. In addition, they were more likely to present with a history of diabetes, hypertension, congestive heart failure, peripheral vascular disease or percutaneous coronary intervention (PCI).
While 5.9% of patients readmitted due to ACS underwent PCI during readmission, 0.82% underwent coronary artery bypass grafting (CABG).
“Revascularization was rarely performed for ACS after TAVR,” the authors wrote. “It was unsurprising that CABG was not frequently performed in the setting, … given that patients requiring TAVR were likely at a high risk for open-heart surgery.”
Patients readmitted due to ACS had a much higher mortality rate (9.9%) than patients readmitted for reasons unrelated to ACS (3.0%). A history of diabetes, congestive heart failure, chronic kidney disease and PCI were all associated with a higher risk of readmission due to ACS. Also, readmission due to ACS was more likely after nonelective TAVR procedures.
The one patient factor directly tied to a higher mortality risk was CABG.
“Considering the risk of complicated access for ACS after TAVR, it is vital to identify patients who are at a high risk for ACS after TAVR for potential treatment beforehand,” the authors wrote. “The present study demonstrated factors associated with ACS readmission after TAVR. Although most of the factors identified in this study are common in any patient with aortic stenosis and may not influence the decision in the timing of PCI, a history of PCI may require further attention.”
Read the full analysis here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.