Abstract

Background: Many patients with calcific aortic stenosis (AS) have concomitant coronary artery disease (CAD) due to similar pathophysiology. Despite these strong associations, few studies have explored how CAD affects treatment outcomes of patients with severe symptomatic AS.   Aim: To assess the effect of CAD on patient mortality following treatment for severe symptomatic AS.   Methods: We conducted a retrospective analysis of 231 symptomatic, high risk patients with severe AS, referred for transcatheter valve replacement (TAVR) from 2007-2010, who were not randomized in the PARTNER study. Patients received surgical aortic valve replacement (SAVR) (n=84), balloon aortic valvuloplasty (BAV) (n=53), or medical management (Med) (n=94), and were followed for ≥ 3 months. We assessed patients’ CAD status based on their Duke Myocardial Jeopardy Score (DMJS) and revascularization history. Surgical risk score was estimated using the Society of Thoracic Surgeons (STS) online risk calculator. Unadjusted survival estimates were obtained for each treatment group using the Kaplan-Meier method. A Cox proportional hazards model was fitted, including treatment, CAD status, treatment-by-CAD interaction, and STS score with time-to-mortality as the primary outcome.   Results: For the Kaplan-Meier survival analysis, patients in the SAVR group had significantly lower mortality risk compared to that in the other treatment groups (logrank p = 0.0002). In the adjusted analysis, patients who received SAVR but not revascularization had lower mortalities compared to Med patients; however, for patients who received revascularization, SAVR did not improve mortality over Med. In addition, patients who received BAV had no survival benefit over Med patients irrespective of CAD status.   Conclusions: CAD severity and management had a significant impact on patient mortality following treatment for severe symptomatic AS. Furthermore, clinically, this effect was dependent on the type of treatment administered.