Effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis
Background: Transcatheter aortic valve replacement (TAVR) has significantly advanced the treatment of severe aortic stenosis (AS), particularly in elderly patients who often have coexisting coronary artery disease (CAD). Chronic total occlusion (CTO), a severe form of CAD, may negatively impact outc...
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Elsevier
2025-03-01
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| Series: | International Journal of Cardiology. Cardiovascular Risk and Prevention |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772487524001211 |
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| author | Aman Goyal Muhammad Daoud Tariq Areeba Ahsan Sonia Hurjkaliani Ajeet Singh Hafiz Muhammad Hamza Hritvik Jain Hareesha Rishab Bharadwaj Mohamed Daoud Abu Baker Sheikh |
| author_facet | Aman Goyal Muhammad Daoud Tariq Areeba Ahsan Sonia Hurjkaliani Ajeet Singh Hafiz Muhammad Hamza Hritvik Jain Hareesha Rishab Bharadwaj Mohamed Daoud Abu Baker Sheikh |
| author_sort | Aman Goyal |
| collection | DOAJ |
| description | Background: Transcatheter aortic valve replacement (TAVR) has significantly advanced the treatment of severe aortic stenosis (AS), particularly in elderly patients who often have coexisting coronary artery disease (CAD). Chronic total occlusion (CTO), a severe form of CAD, may negatively impact outcomes in TAVR patients, though data are limited. This meta-analysis aims to evaluate the impact of CTO on TAVR outcomes. Methods: A comprehensive literature search was conducted across multiple electronic databases to identify studies comparing TAVR outcomes in patients with and without CTO. Pooled risk ratios (RR) with 95 % confidence intervals (CIs) were calculated using a random-effects model. The primary outcome was all-cause mortality, with several secondary endpoints also assessed. Results: Six studies involving a total of 331,159 TAVR patients were included in this meta-analysis. CTO was associated with a significantly increased risk of in-hospital mortality (RR: 1.24; 95 % CI: 1.01, 1.52; p = 0.04), acute myocardial infarction (RR: 1.67; 95 % CI: 1.48, 1.89; p < 0.00001), acute kidney injury (RR: 1.46; 95 % CI: 1.37, 1.56; p < 0.00001), and vascular complications (RR: 1.47; 95 % CI: 1.28, 1.69; p < 0.00001). No significant differences were observed in all-cause mortality (RR: 1.21; 95 % CI: 0.76, 1.93; p = 0.42), stroke (RR: 1.09; 95 % CI: 0.91, 1.30; p = 0.37), or bleeding events (RR: 1.19; 95 % CI: 1.00, 1.41; p = 0.06). Conclusion: CTO poses a significant risk in TAVR patients, particularly for in-hospital mortality and acute myocardial infarction. A multidisciplinary approach is recommended for these patients, with consideration given to revascularization before TAVR. Further studies are needed to evaluate the potential benefits of prior CTO-PCI. |
| format | Article |
| id | doaj-art-aee33dfd7caf4abb855863ddb8b4d920 |
| institution | DOAJ |
| issn | 2772-4875 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | International Journal of Cardiology. Cardiovascular Risk and Prevention |
| spelling | doaj-art-aee33dfd7caf4abb855863ddb8b4d9202025-08-20T02:58:19ZengElsevierInternational Journal of Cardiology. Cardiovascular Risk and Prevention2772-48752025-03-012420035610.1016/j.ijcrp.2024.200356Effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysisAman Goyal0Muhammad Daoud Tariq1Areeba Ahsan2Sonia Hurjkaliani3Ajeet Singh4Hafiz Muhammad Hamza5Hritvik Jain6Hareesha Rishab Bharadwaj7Mohamed Daoud8Abu Baker Sheikh9Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, IndiaDepartment of Internal Medicine, Foundation University Medical College, Islamabad, PakistanDepartment of Internal Medicine, Foundation University Medical College, Islamabad, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, Karachi, PakistanDepartment of Internal Medicine, Dow University of Health Sciences, Karachi, PakistanDepartment of Internal Medicine, Foundation University Medical College, Islamabad, PakistanDepartment of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, IndiaFaculty of Biology Medicine and Health, The University of Manchester, Manchester, UKDepartment of Internal Medicine, Bogomolets National Medical University, Kyiv, Ukraine; Corresponding author. Bogomolets National Medical University, Kyiv, Ukraine.Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USABackground: Transcatheter aortic valve replacement (TAVR) has significantly advanced the treatment of severe aortic stenosis (AS), particularly in elderly patients who often have coexisting coronary artery disease (CAD). Chronic total occlusion (CTO), a severe form of CAD, may negatively impact outcomes in TAVR patients, though data are limited. This meta-analysis aims to evaluate the impact of CTO on TAVR outcomes. Methods: A comprehensive literature search was conducted across multiple electronic databases to identify studies comparing TAVR outcomes in patients with and without CTO. Pooled risk ratios (RR) with 95 % confidence intervals (CIs) were calculated using a random-effects model. The primary outcome was all-cause mortality, with several secondary endpoints also assessed. Results: Six studies involving a total of 331,159 TAVR patients were included in this meta-analysis. CTO was associated with a significantly increased risk of in-hospital mortality (RR: 1.24; 95 % CI: 1.01, 1.52; p = 0.04), acute myocardial infarction (RR: 1.67; 95 % CI: 1.48, 1.89; p < 0.00001), acute kidney injury (RR: 1.46; 95 % CI: 1.37, 1.56; p < 0.00001), and vascular complications (RR: 1.47; 95 % CI: 1.28, 1.69; p < 0.00001). No significant differences were observed in all-cause mortality (RR: 1.21; 95 % CI: 0.76, 1.93; p = 0.42), stroke (RR: 1.09; 95 % CI: 0.91, 1.30; p = 0.37), or bleeding events (RR: 1.19; 95 % CI: 1.00, 1.41; p = 0.06). Conclusion: CTO poses a significant risk in TAVR patients, particularly for in-hospital mortality and acute myocardial infarction. A multidisciplinary approach is recommended for these patients, with consideration given to revascularization before TAVR. Further studies are needed to evaluate the potential benefits of prior CTO-PCI.http://www.sciencedirect.com/science/article/pii/S2772487524001211Chronic total occlusionAortic stenosisTranscatheter aortic valve replacementTAVRCoronary artery disease |
| spellingShingle | Aman Goyal Muhammad Daoud Tariq Areeba Ahsan Sonia Hurjkaliani Ajeet Singh Hafiz Muhammad Hamza Hritvik Jain Hareesha Rishab Bharadwaj Mohamed Daoud Abu Baker Sheikh Effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis International Journal of Cardiology. Cardiovascular Risk and Prevention Chronic total occlusion Aortic stenosis Transcatheter aortic valve replacement TAVR Coronary artery disease |
| title | Effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis |
| title_full | Effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis |
| title_fullStr | Effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis |
| title_full_unstemmed | Effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis |
| title_short | Effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis |
| title_sort | effect of chronic total occlusion of coronary arteries on cardiovascular outcomes in patients undergoing transcatheter aortic valve replacement a systematic review and meta analysis |
| topic | Chronic total occlusion Aortic stenosis Transcatheter aortic valve replacement TAVR Coronary artery disease |
| url | http://www.sciencedirect.com/science/article/pii/S2772487524001211 |
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