Impacto da doença arterial coronariana avaliada pelo escore SYNTAX na evolução de pacientes com estenose aórtica grave submetidos a implante de bioprótese aórtica transcateter

Abstract

Transcatheter aortic valve implantation has become a treatment option for high surgical risk patients with aortic valve stenosis. The impact of coronary artery disease in this context is still unknown. To evaluate the impact of coronary artery disease classified by the SYNTAX score on outcomes of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. Retrospective and prospective single-center study of 135 consecutive patients with severe aortic stenosis and high surgical risk undergoing transcatheter aortic valve implantation from July 2009 to April 2015. Characterization of coronary artery disease by SYNTAX score and evaluation of the impacts on outcomes up to 2 years. The self expadable prosthesis were implanted in 96,3% cases (n=130) and the balloon expandable in 3,7% (n=5). The SYNTAX score preoperatively was calculated by analyzing all coronary angiographies. The coort was divided into 3 groups: patients without coronary artery disease (no CAD, n = 60); patients with SYNTAX ≤22 (CAD 1, n = 59) and patients with SYNTAX score>22 (CAD 2, n = 16). The functional NYHA class III-IV was present in 94.8% of cases. Outcomes were analyzed at 30 days, 180 days, 1 and 2 years. At 180 days there was a >10% increase in ejection fraction mainly from CAD groups (CAD1 < CAD 2) with p = 0.008. The NYHA functional class I-II was present in 96, 3% after 1 year and 96.1% after 2 years. There were no statistically significant differences among the 3 groups by univariate analysis for clinical and cardiovascular outcomes, and also on cardiovascular and global mortality within 2 years. Mortality was 7.4% at 30 days, 12.6% at 180 days, 18% at 1 year and 24.2% at 2 years. Pulmonary hypertension was the only factor identified by multivariate analysis correlated with negative outcomes at all times of evolution, including cardiovascular mortality at 1 year (p = 0.047, HR:1.02) and at 2 years (p = 0.013, HR:1,48). The presence of SYNTAX ≥22 showed a trend (p = 0.061, HR:0,92) relationship to cardiovascular events in 1 year. There was no impact of coronary artery disease assessed by SYNTAX score on outcomes up to 2 years in patients with severe aortic stenosis and high surgical risk treated by transcatheter aortic valve implantation.