{
  "abstract": "Background Coronary Artery Disease(CAD) is the leading cause of mortality among aortic stenosis (AS) patient populations due to common pathogenetic factors such as ageing, atherosclerotic plaques, or procedural related coronary access occlusion, with recent revolution of transcatheter aortic valve implantation (TAVI). 4 The prevalence of atherosclerotic cardiovascular disease (ASCVD) post-TAVI aortic stenotic individuals has become an increasing trend, but its evidence remains debated.Objective This study aims to review the prevalence of coronary artery disease in patients with aortic stenosis who have undergone TAVI and its temporal trends of CAD over the period of post-TAVI follow-up.Methods A systematic review has been conducted following PRISMA guidelines. 5 Relevant studies published between 2014 and 2024 have been identified through a comprehensive search of databases, including PubMed, EMBASE, Google Scholar, Clinical Trials.com, and other sources.The inclusion criteria focus on RCTs evaluating the prevalence of coronary artery disease (CAD), among post-TAVI aortic stenotic patient populations from the year 2014 to 2024. Two independent reviewers have rigorously reviewed the literature systematically to minimise the publication biases and to ensure the quality of systematic review to the standard level. Notably, the exclusion criteria of the proposal have been modified to include studies which recorded any pre-existing coronary artery disease prior to TAVI, since if these studies would be excluded, there would be no RCTs left to analyse. Following the redefined inclusion and exclusion criteria of the study review, we have modified our study for participants to be taken into account when they had pre-existing atherosclerotic coronary artery disease (CAD); this information is crucial to answer the study question around the fact if there was any accelerated coronary artery disease following the TAVI procedures among our study population and increase the number of inclusive trials in our systematic review.Results The search from our systematic review has returned 80 publications. After removal of duplicated publications, there were 64 lefts. 43 records were excluded because they were not Randomized Controlled Trials (RCTs), a further 17 records were excluded due to recruiting prior to 2014, and this left 4 records. From the 4 records 1 was excluded because it was an observational sub-study embedded in a randomised control trial. 3 records 1–3 were left to be reported (table 1& table 2) . The data extracted from the systematic review is not sufficient to proceed with meta-analysis, thus it highlights future primary research on the prevalence of coronary artery disease post-TAVI periods.Conclusion The scarcity of evidence is striking within the PRISM flowchart ( figure 1) .The 20 publications that we identified as RCTs were very quickly reduced to four and then two randomised controlled trials transforming three inclusive clinical studies to be finalized as an outcome. We concluded that the RCTs only reported CAD if the participants deceased or had major clinical incidences; this does not represent the total presence of CAD following the transcatheter aortic valve implantation (TAVI) procedures among the study population. This highlights the lack of data on the total presence of prevalence of coronary artery disease (CAD) after TAVI procedures, which makes it difficult to estimate the success rate and incidence of the percutaneous coronary intervention (PCI) among post-TAVI periods.Abstract 2-026 Figure 1PRISMA flowchart illustrating the total studies included in our systematic reviewTable 1 summarizes the baseline characteristics of our systematic review, in comparison with two included randomised controlled trials from three included papers1,2,3, as follows:Abstract 2-026 Table 1 Baseline Characteristics for TAVI TAVR with a self-expanding valve in low-risk patients (Mack, M.J et al. (2019) ), Partner-3 trials ((Leon,M.B et al. 2021) and (Popma, J.J et al.2019) ) Age — yr74.1±5.873.3±5.8Female sex — no. (%)261 (36.0)161 (32.5)NYHA class — no. (%) I76 (10.5) II467 (64.4) III181 (25.0)155 (31.2)IV1 (0.1)STS-PROM —%1.9±0.71.9±0.7Diabetes mellitus — no. (%)228 (31.4)155 (31.2)Serum creatinine >2 mg/dl — no. (%)3 (0.4)1 (0.2)Dialysis — no. (%)00Hypertension — no./total no. (%)614/724 (84.8)-Peripheral arterial disease — no./total no. (%)54/718 (7.5)34/494 (6.9)Cerebrovascular disease — no. (%)74 (10.2) Chronic obstructive pulmonary disease — no./total no. (%)104/695 (15.0) Previous coronary-artery bypass surgery — no. (%)18 (2.5)137/494 (27.7)Previous percutaneous coronary intervention — no. (%)103 (14.2) Preexisting pacemaker or defibrillator — no. (%)23 (3.2)12 (2.4)Previous myocardial infarction — no. (%)48 (6.6)28/495 (5.7)Previous atrial fibrillation or atrial flutter — no./total no. (%)111/722 (15.4)78/496 (15.7)Aortic-valve gradient — mm Hg47.0±12.149.4±12.8Aortic-valve area — cm20.8±0.20.8±0.2Left ventricular ejection fraction —%61.7±7.965.7±9.0Below is the table 2 where the above results are summarised from three inclusive studies, based upon two randomised controlled trials (RCTs)1,2,3.Abstract 2-026 Table 2 Coronary Artery Disease Deaths due to coronary artery disease including myocardial infarction Randomised Control Trials Baseline 30 days post TAVI 1 year post TAVI 2 years post TAVI Popma JJ et. al. 151/7257/7257/432- PARTNER 3 165/4965/4966/4969/496References Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. New England Journal of Medicine 2019;380(18):1695–1705.Leon MB, Mack MJ, Hahn RT, Thourani VH, Makkar R, Kodali SK, Alu MC, Madhavan MV, Chau, KH, Russo M, Kapadia SR. Outcomes 2 years after transcatheter aortic valve replacement in patients at low surgical risk. Journal of the American College of Cardiology 2021;77(9):1149–1161.Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, Bajwa T, Heiser JC, Merhi W, Kleiman NS, Askew J. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. New England Journal of Medicine 2019;380(18):1706–1715.Kurmani S, Modi B, Mukherjee A, Adlam D, Banning A, Ladwiniec A, Rajendra R, Baron J, Roberts E, Ng A, Squire I. Coronary artery disease and outcomes following transcatheter aortic valve implantation. Open Heart 2024;11(1):e002620.Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, Prisma-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews 2015;4:1–9.",
  "authors": [
    {
      "affiliations": [
        "University Hospital Plymouth"
      ],
      "name": "Khin Kay Kay Kyaw"
    },
    {
      "affiliations": [
        "University Hospital Plymouth"
      ],
      "name": "Thomas Mindos"
    }
  ],
  "title": "2-026 Prevalence of coronary artery disease in patients with aortic stenosis who have undergone transcatheter aortic valve implantation (TAVI): a systematic review",
  "uid": "71abb421-5915-5e65-b6ce-4ae9630a7c79"
}