Incidence of cardiac ischemic events after transcatheter aortic valve replacement: Results from the OBSERVANT studies

Objectives: This analysis aimed to assess the 5-year incidence of cardiac ischemic events following transcatheter aortic valve replacement (TAVR). Background: As TAVR is increasingly used in younger patients with longer life expectancy, there is greater emphasis on preserving access to coronary arteries due to the potential for ischemic events. Limited data exist on the actual frequency of these events following TAVR. Methods: Data were collected from 4750 consecutive patients with severe aortic stenosis undergoing TAVR, from the multicenter OBSERVANT-I and OBSERVANT-II studies. The primary endpoint was hospitalization due to cardiac ischemic events within 5 years after TAVR. Outcomes were adjudicated using administrative databases and reported as cumulative incidence, accounting for the competing risk of death. Results: At 5 years, 8.3 % (95 % CI:7.5-9.1 %) of patients experienced cardiac ischemic events, with the incidence increasing over time. The types of ischemic events included chronic coronary syndrome (3.3 %; 95 % CI:2.8-3.9 %), non-ST-segment elevation myocardial infarction (2.6 %; 95 % CI:2.1-3.1 %), unstable angina (2.3 %; 95 % CI:1.9-2.8 %), and STEMI (0.9 %; 95 % CI:0.7-1.3 %). Unplanned coronary angiography was performed in 5.0 % (95 % CI:4.4-5.7 %) of patients, and percutaneous coronary intervention in 2.6 % (95 % CI:2.1-3.1 %). Patients with ≥2-vessel coronary artery disease (CAD) at baseline had a higher risk of ischemic events (17.6 %; 95 % CI:14.6-21.2 %) compared to those with single-vessel CAD (12.0 %; 95 % CI:9.9-14.6 %) or no CAD (5.9 %; 95 % CI:5.9-6.8 %). Conclusions: In this TAVR cohort, 8.3 % of patients experienced cardiac ischemic events at 5 years. The presence of multivessel CAD at baseline was associated with a significantly higher risk of ischemic events compared to patients without CAD.