Stephan T, Thoma E, Rattka M, et al. - In patients undergoing transcatheter aortic valve replacement (TAVR) and having concomitant coronary artery disease (CAD), an improved prognosis post-TAVR may be achieved by implementing a residual SYNTAX score (SS)-guided revascularization strategy. Improved one-year clinical results can be obtained with percutaneous coronary intervention (PCI) aiming for a residual SS < 8.

• A total of 553 patients with severe aortic stenosis undergoing TAVR were analyzed; 60.2% of patients (n = 333) had CAD with a mean SS of 10.8 ± 8.8 and of those, 36.0% (n=120) underwent periprocedural PCI.

• Presence vs absence of concomitant CAD was linked with more frequent occurrence of myocardial infarction (MI) post TAVR (2.1% vs. 0.0%).

• Comparable MI rates were noted between cases with and without PCI among CAD patients (2.2% vs. 2.5%).

• Significant lower rates of one-year mortality (9.0% vs 18.2%) and major adverse cardiac and cerebrovascular events (16.5% vs 32.2%) were observed in patients with a residual SS < 8.

• Besides left bundle brunch, a residual SS ≥ 8 and a EuroSCORE (European System for Cardiac Operative Risk Evaluation) ≥ 4% were predictors for an elevated one-year mortality in the CAD group (odds ratio OR = 3.17) and in whole study sample (OR = 2.18), respectively.