Routine screening of coronary artery disease with computed tomographic coronary angiography in place of invasive coronary angiography in patients undergoing transcatheter aortic valve replacement

Alaide Chieffo, Gennaro Giustino, Pietro Spagnolo, Vasileios F. Panoulas, Matteo Montorfano, Azeem Latib, Filippo Figini, Eustachio Agricola, Chiara Gerli, Annalisa Franco, Manuela Giglio, Micaela Cioni, Ottavio Alfieri, Paolo Guido Camici, Antonio Colombo

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background-Coronary artery disease (CAD) screening is required before transcatheter aortic valve implantation (TAVR). Although invasive coronary angiography (CA) remains the gold standard for CAD assessment, computed tomographic CA (CTCA) could be a safe and effective noninvasive alternative for CAD screening in patients undergoing TAVR. Methods and Results-From November 2007 to May 2013, all patients undergoing TAVR at our institution were included in the study cohort. CTCA was used as first-line imaging tool for CAD screening. Invasive CA was performed when any of the following were present: coronary anatomy at CTCA was not evaluable and presence of significant CAD at CTCA. The primary objective was to compare major adverse cardiovascular and cerebrovascular events at 30 days and 1 year between patients who performed CTCA as only screening test and those who performed CTCA and invasive CA. Of 491 patients treated with TAVR, 375 (76.3%) performed only CTCA, whereas 116 (21.7%) underwent also CA. No differences were present in crude major adverse cardiovascular and cerebrovascular event rates at 30 days and 1 year between the 2 groups. After multivariable adjustment, CTCA performed alone was not associated with higher risk of MACE at 1 year of follow-up (hazard ratio, 0.89; 95% confidence interval, 0.49-1.60; P=0.69). Conclusions-CTCA performed as a routine noninvasive imaging tool in patients undergoing TAVR seems safe and effective allowing, with a single test, acquisition of information on aortic annulus anatomy, peripheral access sites, and evaluation of coronary anatomy.

Original languageEnglish
Article numbere002025
JournalCirculation: Cardiovascular Interventions
Volume8
Issue number7
DOIs
Publication statusPublished - May 1 2015

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Coronary Angiography
Coronary Artery Disease
Anatomy
Cohort Studies
Transcatheter Aortic Valve Replacement
Confidence Intervals

Keywords

  • Aortic Valve Stenosis
  • Coronary Angiography
  • Coronary Artery Disease
  • Follow-Up Studies
  • Transcatheter Aortic Valve Replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Routine screening of coronary artery disease with computed tomographic coronary angiography in place of invasive coronary angiography in patients undergoing transcatheter aortic valve replacement. / Chieffo, Alaide; Giustino, Gennaro; Spagnolo, Pietro; Panoulas, Vasileios F.; Montorfano, Matteo; Latib, Azeem; Figini, Filippo; Agricola, Eustachio; Gerli, Chiara; Franco, Annalisa; Giglio, Manuela; Cioni, Micaela; Alfieri, Ottavio; Camici, Paolo Guido; Colombo, Antonio.

In: Circulation: Cardiovascular Interventions, Vol. 8, No. 7, e002025, 01.05.2015.

Research output: Contribution to journalArticle

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title = "Routine screening of coronary artery disease with computed tomographic coronary angiography in place of invasive coronary angiography in patients undergoing transcatheter aortic valve replacement",
abstract = "Background-Coronary artery disease (CAD) screening is required before transcatheter aortic valve implantation (TAVR). Although invasive coronary angiography (CA) remains the gold standard for CAD assessment, computed tomographic CA (CTCA) could be a safe and effective noninvasive alternative for CAD screening in patients undergoing TAVR. Methods and Results-From November 2007 to May 2013, all patients undergoing TAVR at our institution were included in the study cohort. CTCA was used as first-line imaging tool for CAD screening. Invasive CA was performed when any of the following were present: coronary anatomy at CTCA was not evaluable and presence of significant CAD at CTCA. The primary objective was to compare major adverse cardiovascular and cerebrovascular events at 30 days and 1 year between patients who performed CTCA as only screening test and those who performed CTCA and invasive CA. Of 491 patients treated with TAVR, 375 (76.3{\%}) performed only CTCA, whereas 116 (21.7{\%}) underwent also CA. No differences were present in crude major adverse cardiovascular and cerebrovascular event rates at 30 days and 1 year between the 2 groups. After multivariable adjustment, CTCA performed alone was not associated with higher risk of MACE at 1 year of follow-up (hazard ratio, 0.89; 95{\%} confidence interval, 0.49-1.60; P=0.69). Conclusions-CTCA performed as a routine noninvasive imaging tool in patients undergoing TAVR seems safe and effective allowing, with a single test, acquisition of information on aortic annulus anatomy, peripheral access sites, and evaluation of coronary anatomy.",
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T1 - Routine screening of coronary artery disease with computed tomographic coronary angiography in place of invasive coronary angiography in patients undergoing transcatheter aortic valve replacement

AU - Chieffo, Alaide

AU - Giustino, Gennaro

AU - Spagnolo, Pietro

AU - Panoulas, Vasileios F.

AU - Montorfano, Matteo

AU - Latib, Azeem

AU - Figini, Filippo

AU - Agricola, Eustachio

AU - Gerli, Chiara

AU - Franco, Annalisa

AU - Giglio, Manuela

AU - Cioni, Micaela

AU - Alfieri, Ottavio

AU - Camici, Paolo Guido

AU - Colombo, Antonio

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background-Coronary artery disease (CAD) screening is required before transcatheter aortic valve implantation (TAVR). Although invasive coronary angiography (CA) remains the gold standard for CAD assessment, computed tomographic CA (CTCA) could be a safe and effective noninvasive alternative for CAD screening in patients undergoing TAVR. Methods and Results-From November 2007 to May 2013, all patients undergoing TAVR at our institution were included in the study cohort. CTCA was used as first-line imaging tool for CAD screening. Invasive CA was performed when any of the following were present: coronary anatomy at CTCA was not evaluable and presence of significant CAD at CTCA. The primary objective was to compare major adverse cardiovascular and cerebrovascular events at 30 days and 1 year between patients who performed CTCA as only screening test and those who performed CTCA and invasive CA. Of 491 patients treated with TAVR, 375 (76.3%) performed only CTCA, whereas 116 (21.7%) underwent also CA. No differences were present in crude major adverse cardiovascular and cerebrovascular event rates at 30 days and 1 year between the 2 groups. After multivariable adjustment, CTCA performed alone was not associated with higher risk of MACE at 1 year of follow-up (hazard ratio, 0.89; 95% confidence interval, 0.49-1.60; P=0.69). Conclusions-CTCA performed as a routine noninvasive imaging tool in patients undergoing TAVR seems safe and effective allowing, with a single test, acquisition of information on aortic annulus anatomy, peripheral access sites, and evaluation of coronary anatomy.

AB - Background-Coronary artery disease (CAD) screening is required before transcatheter aortic valve implantation (TAVR). Although invasive coronary angiography (CA) remains the gold standard for CAD assessment, computed tomographic CA (CTCA) could be a safe and effective noninvasive alternative for CAD screening in patients undergoing TAVR. Methods and Results-From November 2007 to May 2013, all patients undergoing TAVR at our institution were included in the study cohort. CTCA was used as first-line imaging tool for CAD screening. Invasive CA was performed when any of the following were present: coronary anatomy at CTCA was not evaluable and presence of significant CAD at CTCA. The primary objective was to compare major adverse cardiovascular and cerebrovascular events at 30 days and 1 year between patients who performed CTCA as only screening test and those who performed CTCA and invasive CA. Of 491 patients treated with TAVR, 375 (76.3%) performed only CTCA, whereas 116 (21.7%) underwent also CA. No differences were present in crude major adverse cardiovascular and cerebrovascular event rates at 30 days and 1 year between the 2 groups. After multivariable adjustment, CTCA performed alone was not associated with higher risk of MACE at 1 year of follow-up (hazard ratio, 0.89; 95% confidence interval, 0.49-1.60; P=0.69). Conclusions-CTCA performed as a routine noninvasive imaging tool in patients undergoing TAVR seems safe and effective allowing, with a single test, acquisition of information on aortic annulus anatomy, peripheral access sites, and evaluation of coronary anatomy.

KW - Aortic Valve Stenosis

KW - Coronary Angiography

KW - Coronary Artery Disease

KW - Follow-Up Studies

KW - Transcatheter Aortic Valve Replacement

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