Background: Degenerative aortic valve disease and atherosclerotic vascular disease (ASCVD) frequently coexist. ASCVD may impact pre-procedural planning and patient outcomes.
Aims: To systematically quantify the prevalence and prognostic significance of prior coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular event (CVE) in patients undergoing transcatheter aortic valve implantation (TAVI).
Methods: A systematic literature search was conducted to identify studies reporting the prevalence of baseline ASCVD in patients undergoing TAVI. Meta-analyses were conducted to synthesize 1) the prevalence of pre-existing CAD, PAD and CVE in patients undergoing TAVI and 2) the prognostic effects of these comorbidities for post-TAVI mortality.
Results: A total of 43 studies (14 randomized) fulfilled the inclusion criteria encompassing a total of 732,895 patients undergoing TAVI (51 % males, pooled mean age of 81.2 years and Society of Thoracic Surgeons' score of 5.3). Of these, 48 % (42-55 %) had pre-existing CAD, 16 % (13-20 %) had PAD, and 11 % (9-12 %) had suffered a prior CVE. The baseline presence of CAD, PAD and CVE was independently linked with worse prognosis. Significant heterogeneity was observed among included studies, partially explained by differences in sample size, geographical location, and baseline patient characteristics.
Conclusions: This aggregate meta-analysis of large-scale studies yielded a high prevalence of ASCVD in patients undergoing TAVI. Every second patient had CAD, every sixth patient had PAD and 1 out of 10 had CVE. The presence of each comorbidity increased independently the risk of long-term mortality. These findings can help navigate pre-procedural planning, resource allocation, and ultimately optimize overall TAVI outcomes.
Keywords: Aortic stenosis; Atherosclerosis; Coronary artery disease; Peripheral artery disease; Stroke; TAVI; Transcatheter aortic valve implantation.
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