Having normal coronary arteries boosts survival in severe aortic stenosis

The presence of normal coronary arteries improves survival among patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI), a recent study has found.

A total of 987 severe AS patients (mean age, 81.3±7.2 years; 49 percent women) were enrolled. Those without coronary lesions with diameter stenosis ≥30 percent in vessels ≥1.5 mm wide, as detected by coronary angiogram, were defined as having normal coronary arteries (n=258). The primary study outcome was 1-year mortality.

After 12 months of observation, 143 patients died, most of which (n=104) were due to cardiovascular causes. Classifying according to coronary artery status showed that those with normal arteries vs coronary atherosclerosis had comparable 30-day mortality rates (3.1 percent vs 5.6 percent; p=0.11), but by 1 year, the latter had significantly eclipsed the former (8.9 percent vs 17 percent; p=0.003).

Multivariable Cox proportional hazard analysis confirmed that having normal coronary arteries was a significant inverse predictor of 1-year mortality, almost halving the risk (adjusted hazard ratio, 0.57, 95 percent confidence interval, 0.37–0.90; p=0.02).

Estimated glomerular filtration rate also emerged as an inverse correlate, while chronic obstructive pulmonary disease, age, and peripheral arterial disease were direct risk factors.

“Patients with normal coronary arteries were mostly women, had a different baseline risk profile, and a lower comorbidity burden. Despite these differences in patient characteristics, the severity of AS and aortic valve calcification were absolutely comparable,” the researchers said.

“Hence, coronary atherosclerosis should be incorporated into the risk stratification of patients with severe AS, and personalized revascularization strategies need to be defined,” they added.