Coronary artery disease (CAD) frequently coexists with structural heart disease, yet its prognostic significance in patients undergoing tricuspid transcatheter edge-to-edge repair (T-TEER) remains poorly defined. A study published in the JACC Cardiovascular Interventions evaluated the prevalence, complexity, and impact of CAD and residual coronary disease burden on clinical outcomes following T-TEER.

This observational study included 361 consecutive patients undergoing T-TEER who underwent preprocedural coronary angiography with assessment of coronary lesion complexity using the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score. CAD was defined as ≥70% coronary stenosis or ≥50% stenosis of the left main coronary artery. Residual SYNTAX scores were calculated in patients who underwent coronary revascularization.

Findings

• Obstructive CAD was present in 34.3% of T-TEER candidates, with predominantly low-complexity coronary anatomy (median SYNTAX score 6).
• During 12 months of follow-up, all-cause mortality was 16.7% across the study population.
• The presence of obstructive CAD was not associated with increased mortality compared with patients without CAD (12-month mortality: 17.5% vs 16.3%; log-rank P = 0.616).
• Neither baseline SYNTAX score nor residual SYNTAX score predicted mortality in the overall cohort.
• Among patients with low or intermediate procedural risk according to TRI-SCORE, elevated residual SYNTAX scores were associated with significantly higher 12-month mortality (20.8% vs 6.4%; log-rank P = 0.016), and inclusion of residual SYNTAX improved risk discrimination (ΔC = +0.099).

The investigators concluded that obstructive CAD is common among patients undergoing T-TEER but is generally characterized by low anatomical complexity and does not independently affect overall survival.