Coronary assessment before transcatheter aortic valve implantation (TAVI) remains challenging in elderly patients with multiple comorbidities because invasive coronary angiography (ICA) may increase procedural burden and complication risk. A retrospective single-center study published in the Journal of Personalized Medicine evaluated whether coronary computed tomography angiography (cCTA) could safely replace ICA for excluding obstructive coronary artery disease (O-CAD) before TAVI.
The analysis included consecutive patients with severe symptomatic aortic stenosis undergoing TAVI between January 2019 and December 2020. All participants underwent preprocedural cCTA. Patients with positive or inconclusive cCTA findings selectively underwent ICA, whereas those without evidence of O-CAD proceeded directly to TAVI without invasive angiography. Long-term outcomes were assessed for up to 5 years.
Findings
- Among 210 evaluated patients, negative cCTA findings for O-CAD were identified in 140 patients (66.7%), and ICA was omitted in 132 patients (62.8%).
- cCTA findings were inconclusive in 43 patients (20.5%) and positive in 27 patients (12.9%).
- Among patients undergoing ICA, O-CAD was confirmed in 53 of 78 patients (67.9%), while overall cCTA accuracy for ruling in O-CAD was 66.3%.
- During a mean follow-up of 1,513 ± 508 days, rates of major adverse cardiovascular events (MACEs), mortality, heart failure hospitalization, and unplanned revascularization were comparable between the no-ICA and ICA groups.
- Comparable outcomes between groups remained consistent after matched-pair analyses.
A cCTA-guided strategy safely reduced the need for invasive coronary angiography in selected elderly patients undergoing TAVI when image quality was diagnostic and O-CAD was excluded.The findings support a more individualized preprocedural coronary assessment approach in appropriately selected patients.
