Skip to main content
SpringerLink
Log in

Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations

  • Original Article
  • Published:
Journal of Cardiovascular Translational Research Aims and scope Submit manuscript

Abstract

We evaluated the clinical outcome of patients with moderate/severe aortic stenosis and significant coronary disease not treated according to guidelines, recommending combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). From 2002 to 2010, we assessed death up to 5 years in 650 patients with moderate/severe aortic stenosis and at least one coronary lesion (>50 %): 23 % were treated conservatively (MT), 17 % with percutaneous coronary intervention (PCI), 11 % with AVR, and 49 % with combined CABG and AVR. At a median follow-up of 58 months, overall death decreased over the groups (MT, 68 % vs. PCI, 44 % vs. AVR, 34 % vs. CABG and AVR, 23 %, p < 0.01). Compared to the MT group, Cox regression analysis adjusted for potential confounders showed significantly reduced mortality in the PCI, AVR, and CABG and AVR groups. When combined CABG and AVR is not feasible, PCI or AVR alone still improves significantly long-term survival as compared with MT alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

AS:

Aortic stenosis

AVR:

Aortic valve replacement

AVA:

Aortic valve area

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

DES:

Drug-eluting stents

LVEF:

Left ventricular ejection fraction

MT:

Medical therapy

PCI:

Percutaneous coronary intervention

TAVR:

Transcatheter aortic valve replacement

References

  1. Carabello, P. A., & Paulus, W. J. (2009). Aortic stenosis. Lancet, 373(9667), 956–966.

    Article  PubMed  Google Scholar 

  2. Bateman, M. G., Hill, A. J., Quill, J. L., & Iaizzo, P. A. (2013). The clinical anatomy and pathology of the human arterial valves: implications for repair or replacement. Journal of Cardiovascular Translational Research, 6(2), 166–175.

    Article  PubMed  Google Scholar 

  3. Vandeplas, A., Willems, J. L., Piessens, J., & De Geest, H. (1988). Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis. American Journal of Cardiology, 62, 117–120.

    Article  CAS  PubMed  Google Scholar 

  4. Exadactylos, N., Sugrue, D. D., & Oakley, C. M. (1984). Prevalence of coronary artery disease in patients with isolated aortic valve stenosis. British Heart Journal, 51, 121–124.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin, J. P., Guyton, R. A., O’Gara, P. T., Ruiz, C. E., Skubas, N. J., Sorajja, P., Sundt, T. M., & Thomas, J. D. (2014). 2014 AHA/ACC Guideline for the Management of Patients with Valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 129(23), e521–e643.

    Article  PubMed  Google Scholar 

  6. Vahanian, A., Baumgartner, H., Bax, J., Butchart, E., Dion, R., Filippatos, G., Flachskampf, F., Hall, R., Iung, B., Kasprzak, J., Nataf, P., Tornos, P., Torracca, L., & Wenink, A. (2012). Task Force on the Management of Valvular Hearth Disease of the European Society of Cardiology, ESC Committee for Practice Guidelines. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal, 33, 2451–2496.

    Article  PubMed  Google Scholar 

  7. Ryan, T. J., Faxon, D. P., Gunnar, R. M., Kennedy, J. W., King, S. B., 3rd, Loop, F. D., Peterson, K. L., Reeves, T. J., Williams, D. O., Winters, W. L., Jr., et al. (1988). Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation, 78(2), 486–502.

    Article  CAS  PubMed  Google Scholar 

  8. Czer, L. S., Gray, R. J., Stewart, M. E., De Robertis, M., Chaux, A., & Matloff, J. M. (1988). Reduction in sudden late death by concomitant revascularization with aortic valve replacement. Journal of Thoracic and Cardiovascular Surgery, 95(3), 390–401.

    CAS  PubMed  Google Scholar 

  9. Iung, B., Drissi, M. F., Michel, P. L., de Pamphilis, O., Tsezana, R., Cormier, B., Vahanian, A., & Acar, J. (1993). Prognosis of valve replacement for aortic stenosis with or without coexisting coronary heart disease: a comparative study. Journal of Heart Valve Disease, 2(4), 430–439.

    CAS  PubMed  Google Scholar 

  10. Lund, O., Nielsen, T. T., Pilegaard, H. K., Magnussen, K., & Knudsen, M. A. (1990). The influence of coronary artery disease and bypass grafting on early and late survival after valve replacement for aortic stenosis. Journal of Thoracic and Cardiovascular Surgery, 100(3), 327–337.

    CAS  PubMed  Google Scholar 

  11. Beach, J. M., Mihaljevic, T., Svensson, L. G., Rajeswaran, J., Marwick, T., Griffin, B., Johnston, D. R., Sabik, J. F., III, & Blackstone, E. H. (2013). Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. Journal of the American College of Cardiology, 61, 837–848.

    Article  PubMed  PubMed Central  Google Scholar 

  12. de Waard, G. A., Jansen, E. K., de Mulder, M., Vonk, A. B., & Umans, V. A. (2012). Long-term outcomes of isolated aortic valve replacement and concomitant AVR and coronary artery bypass grafting. Netherlands Heart Journal, 20(3), 110–117.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Steinberg, D. H., Castillo-Sang, M., & Powers, E. R. (2014). Advances in transcatheter valve therapies. Journal of Cardiovascular Translational Research, 7(4), 375–386.

    Article  PubMed  Google Scholar 

  14. Dewey, T. M., Brown, D. L., Herbert, M. A., Culica, D., Smith, C. R., Leon, M. B., Svensson, L. G., Tuzcu, M., Webb, J. G., Cribier, A., & Mack, M. J. (2010). Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation. Annals of Thoracic Surgery, 89, 758–767.

    Article  PubMed  Google Scholar 

  15. Masson, J. B., Lee, M., Boone, R. H., Ali Al, A., Bugami Al, S., Hamburger, J., John Mancini, G. B., Ye, J., Cheung, A., Humphries, K. H., Wood, D., Nietlispach, F., & Webb, J. G. (2010). Impact of coronary artery disease on outcomes after transcatheter aortic valve implantation. Catheterization and Cardiovascular Interventions, 76, 165–173.

    Article  PubMed  Google Scholar 

  16. Wenaweser, P., Pilgrim, T., Guerios, E., Stortecky, S., Huber, C., Khattab, A. A., Kadner, A., Buellesfeld, L., Gloekler, S., Meier, B., Carrel, T., & Windecker, S. (2011). Impact of coronary artery disease and percutaneous coronary intervention on outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. EuroIntervention, 7, 541–548.

    Article  PubMed  Google Scholar 

  17. Khawaja, M. Z., Asrress, K. N., Haran, H., Arri, S., Nadra, I., Bolter, K., Wilson, K., Clack, L., Hancock, J., Young, C. P., Bapat, V., Thomas, M., & Redwood, S. (2015). The effect of coronary artery disease defined by quantitative coronary angiography and SYNTAX score upon outcome after transcatheter aortic valve implantation (TAVI) using the Edwards bioprosthesis. EuroIntervention, 11(4), 450–455.

    Article  PubMed  Google Scholar 

  18. Stefanini, G. G., Stortecky, S., Cao, D., Rat-Wirtzler, J., O’Sullivan, C. J., Gloekler, S., Buellesfeld, L., Khattab, A. A., Nietlispach, F., Pilgrim, T., Huber, C., Carrel, T., Meier, B., Jüni, P., Wenaweser, P., & Windecker, S. (2014). Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation. European Heart Journal, 35(37), 2530–2540.

    Article  PubMed  Google Scholar 

  19. Van Mieghem, N. M., van der Boon, R. M., Faqiri, E., Diletti, R., Schultz, C., van Geuns, R. J., Serruys, P. W., Kappetein, A. P., van Domburg, R. T., & de Jaegere, P. P. (2013). Complete revascularization is not a prerequisite for success in current transcatheter aortic valve implantation practice. JACC. Cardiovascular Interventions, 6(8), 867–875.

    Article  PubMed  Google Scholar 

  20. Goel, S. S., Agarwal, S., Tuzcu, E. M., Ellis, S. G., Svensson, L. G., Zaman, T., Bajaj, N., Joseph, L., Patel, N. S., Aksoy, O., Stewart, W. J., Griffin, B. P., & Kapadia, S. R. (2012). Percutaneous coronary intervention in patients with severe aortic stenosis: implications for transcatheter aortic valve replacement. Circulation, 125(8), 1005–1013.

    Article  PubMed  Google Scholar 

  21. Alcalai, R., Viola, N., Mosseri, M., Beeri, R., Leibowitz, D., Lotan, C., & Gilon, D. (2007). The value of percutaneous coronary intervention in aortic valve stenosis with coronary artery disease. American Journal of Medicine, 120(2), 185.e7–13.

    Article  Google Scholar 

  22. Kuchulakanti, P., Rha, S. W., Satler, L. F., Suddath, W. O., Pichard, A. D., Kent, K. M., Weissman, N. J., Cheneau, E., Pakala, R., Canos, D. A., Pinnow, E. E., & Waksman, R. (2004). Safety of percutaneous coronary intervention alone in symptomatic patients with moderate and severe valvular aortic stenosis and coexisting coronary artery disease: analysis of results in 56 patients. The Journal of Invasive Cardiology, 16, 688–691.

    PubMed  Google Scholar 

  23. Gasparetto, V., Fraccaro, C., Tarantini, G., Buja, P., D’Onofrio, A., Yzeiraj, E., Pittarello, D., Isabella, G., Gerosa, G., Iliceto, S., & Napodano, M. (2013). Safety and effectiveness of a selective strategy for coronary artery revascularization before transcatheter aortic valve implantation. Catheterization and Cardiovascular Interventions, 81, 376–383.

    Article  PubMed  Google Scholar 

  24. Abramowitz, Y., Banai, S., Katz, G., Steinvil, A., Arbel, Y., Havakuk, O., Halkin, A., Ben-Gal, Y., Keren, G., & Finkelstein, A. (2014). Comparison of early and late outcomes of TAVI alone compared to TAVI plus PCI in aortic stenosis patients with and without coronary artery disease. Catheterization and Cardiovascular Interventions, 83(4), 649–654.

    Article  PubMed  Google Scholar 

  25. Abdel-Wahab, M., Mostafa, A. E., Geist, V., Stöcker, B., Gordian, K., Merten, C., Richardt, D., Toelg, R., & Richardt, G. (2012). Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention. The American Journal of Cardiology, 109, 581–586.

    Article  PubMed  Google Scholar 

  26. Wendt, D., Kahlert, P., Lenze, T., Neuhäuser, M., Price, V., Konorza, T., Erbel, R., Jakob, H., & Thielmann, M. (2013). Management of high-risk patients with aortic stenosis and coronary artery disease. Annals of Thoracic Surgery, 95, 599–605.

    Article  PubMed  Google Scholar 

  27. Conradi, L., Seiffert, M., Franzen, O., Baldus, S., Schirmer, J., Meinertz, T., Reichenspurner, H., & Treede, H. (2011). First experience with transcatheter aortic valve implantation and concomitant percutaneous coronary intervention. Clinical Research in Cardiology, 100, 311–316.

    Article  PubMed  Google Scholar 

  28. Pasic, M., Dreysse, S., Unbehaun, A., Buz, S., Drews, T., Klein, C., D’Ancona, G., & Hetzer, R. (2012). Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation. Interactive Cardiovascular and Thoracic Surgery, 14, 463–468.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Chalmers, J., Pullan, M., Fabri, B., McShane, J., Shaw, M., Mediratta, N., & Poullis, M. (2013). Validation of EuroSCORE II in a modern cohort of patients undergoing cardiac surgery. European Journal of Cardio-Thoracic Surgery, 43(4), 688–694.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiovascular Research Center Aalst, OLV Hospital, Moorselbaan n. 164, B-9300, Aalst, Belgium

    Giuseppe Di Gioia, Mariano Pellicano, Gabor G. Toth, Filip Casselman, Julien Adjedj, Frank Van Praet, Bernard Stockman, Ivan Degrieck, William Wijns, Bernard De Bruyne & Emanuele Barbato

  2. Division of Cardiology, Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy

    Giuseppe Di Gioia, Mariano Pellicano, Bruno Trimarco & Emanuele Barbato

  3. University Heart Center Graz, Graz, Austria

    Gabor G. Toth

Authors
  1. Giuseppe Di Gioia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariano Pellicano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabor G. Toth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Filip Casselman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julien Adjedj
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank Van Praet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bernard Stockman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ivan Degrieck
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bruno Trimarco
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. William Wijns
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bernard De Bruyne
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Emanuele Barbato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emanuele Barbato.

Ethics declarations

The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki (revised in 2000) as reflected in a priori approval by the institutional medical ethics committee. Informed consent was obtained from each patient.

Sources of Funding

None.

Conflict of Interest

The authors declare that they have no competing interests.

Additional information

Associate Editor Angela Taylor oversaw the review of this article

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Gioia, G., Pellicano, M., Toth, G.G. et al. Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations. J. of Cardiovasc. Trans. Res. 9, 145–152 (2016). https://doi.org/10.1007/s12265-016-9680-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12265-016-9680-6

Keywords

Search

Navigation