Coronary Obstruction From TAVR in Native Aortic Stenosis: Development and Validation of Multivariate Prediction Model
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Coronary Obstruction From TAVR in Native Aortic Stenosis: Development and Validation of Multivariate Prediction Model. / Khan, Jaffar M; Kamioka, Norihiko; Lisko, John C; Perdoncin, Emily; Zhang, Cheng; Maini, Aneel; Chen, Mao; Li, Yijian; Ludwig, Sebastian; Westermann, Dirk; Amat Santos, Ignacio J; Kalińczuk, Łukasz; Sinning, Jan-Malte; Kawaguchi, Tomohiro; Fuku, Yasushi; Cheema, Asim N; Félix-Oliveira, Afonso; Yamamoto, Masanori; Kagase, Ai; Codner, Pablo; Valle, Raquel Del; Iyer, Vijay S; Kim, Hyo-Soo; Lin, Mao-Shin; Maini, Brijeshwar; Rodriguez, Roberto; Montorfano, Matteo; Ancona, Marco B; Tada, Norio; Miyasaka, Masaki; Ahmad, Hasan; Ruggiero, Nicholas J; Torguson, Rebecca; Ben-Dor, Itsik; Shults, Christian C; Weissman, Gaby; Lederman, Robert J; Greenbaum, Adam B; Babaliaros, Vasilis C; Waksman, Ron; Rogers, Toby.
in: JACC-CARDIOVASC INTE, Jahrgang 16, Nr. 4, 27.02.2023, S. 415-425.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Coronary Obstruction From TAVR in Native Aortic Stenosis: Development and Validation of Multivariate Prediction Model
AU - Khan, Jaffar M
AU - Kamioka, Norihiko
AU - Lisko, John C
AU - Perdoncin, Emily
AU - Zhang, Cheng
AU - Maini, Aneel
AU - Chen, Mao
AU - Li, Yijian
AU - Ludwig, Sebastian
AU - Westermann, Dirk
AU - Amat Santos, Ignacio J
AU - Kalińczuk, Łukasz
AU - Sinning, Jan-Malte
AU - Kawaguchi, Tomohiro
AU - Fuku, Yasushi
AU - Cheema, Asim N
AU - Félix-Oliveira, Afonso
AU - Yamamoto, Masanori
AU - Kagase, Ai
AU - Codner, Pablo
AU - Valle, Raquel Del
AU - Iyer, Vijay S
AU - Kim, Hyo-Soo
AU - Lin, Mao-Shin
AU - Maini, Brijeshwar
AU - Rodriguez, Roberto
AU - Montorfano, Matteo
AU - Ancona, Marco B
AU - Tada, Norio
AU - Miyasaka, Masaki
AU - Ahmad, Hasan
AU - Ruggiero, Nicholas J
AU - Torguson, Rebecca
AU - Ben-Dor, Itsik
AU - Shults, Christian C
AU - Weissman, Gaby
AU - Lederman, Robert J
AU - Greenbaum, Adam B
AU - Babaliaros, Vasilis C
AU - Waksman, Ron
AU - Rogers, Toby
N1 - Copyright © 2023 American College of Cardiology Foundation. All rights reserved.
PY - 2023/2/27
Y1 - 2023/2/27
N2 - BACKGROUND: Transcatheter aortic valve replacement (TAVR)-related coronary artery obstruction prediction remains unsatisfactory despite high mortality and novel preventive therapies.OBJECTIVES: This study sought to develop a predictive model for TAVR-related coronary obstruction in native aortic stenosis.METHODS: Preprocedure computed tomography and fluoroscopy images of patients in whom TAVR caused coronary artery obstruction were collected. Central laboratories made measurements, which were compared with unobstructed patients from a single-center database. A multivariate model was developed and validated against a 1:1 propensity-matched subselection of the unobstructed cohort.RESULTS: Sixty patients with angiographically confirmed coronary obstruction and 1,381 without obstruction were included. In-hospital death was higher in the obstruction cohort (26.7% vs 0.7%; P < 0.001). Annular area and perimeter, coronary height, sinus width, and sinotubular junction height and width were all significantly smaller in the obstructed cohort. Obstruction was most common on the left side (78.3%) and at the level of the coronary artery ostium (92.1%). Coronary artery height and sinus width, but not annulus area, were significant risk factors for obstruction by logistic regression but performed poorly in predicting obstruction. The new multivariate model (coronary obstruction IF cusp height > coronary height, AND virtual valve-to-coronary distance ≤4 mm OR culprit leaflet calcium volume >600 mm3) performed well, with an area under the curve of 0.93 (sensitivity = 0.93, specificity = 0.84) for the left coronary artery and 0.94 (sensitivity = 0.92, specificity = 0.96) for the right.CONCLUSIONS: A novel computed tomography-based multivariate prediction model that can be implemented routinely in real-world practice predicted coronary artery obstruction from TAVR in native aortic stenosis.
AB - BACKGROUND: Transcatheter aortic valve replacement (TAVR)-related coronary artery obstruction prediction remains unsatisfactory despite high mortality and novel preventive therapies.OBJECTIVES: This study sought to develop a predictive model for TAVR-related coronary obstruction in native aortic stenosis.METHODS: Preprocedure computed tomography and fluoroscopy images of patients in whom TAVR caused coronary artery obstruction were collected. Central laboratories made measurements, which were compared with unobstructed patients from a single-center database. A multivariate model was developed and validated against a 1:1 propensity-matched subselection of the unobstructed cohort.RESULTS: Sixty patients with angiographically confirmed coronary obstruction and 1,381 without obstruction were included. In-hospital death was higher in the obstruction cohort (26.7% vs 0.7%; P < 0.001). Annular area and perimeter, coronary height, sinus width, and sinotubular junction height and width were all significantly smaller in the obstructed cohort. Obstruction was most common on the left side (78.3%) and at the level of the coronary artery ostium (92.1%). Coronary artery height and sinus width, but not annulus area, were significant risk factors for obstruction by logistic regression but performed poorly in predicting obstruction. The new multivariate model (coronary obstruction IF cusp height > coronary height, AND virtual valve-to-coronary distance ≤4 mm OR culprit leaflet calcium volume >600 mm3) performed well, with an area under the curve of 0.93 (sensitivity = 0.93, specificity = 0.84) for the left coronary artery and 0.94 (sensitivity = 0.92, specificity = 0.96) for the right.CONCLUSIONS: A novel computed tomography-based multivariate prediction model that can be implemented routinely in real-world practice predicted coronary artery obstruction from TAVR in native aortic stenosis.
KW - Humans
KW - Transcatheter Aortic Valve Replacement
KW - Hospital Mortality
KW - Treatment Outcome
KW - Aortic Valve Stenosis
KW - Heart
KW - Coronary Occlusion
U2 - 10.1016/j.jcin.2022.11.018
DO - 10.1016/j.jcin.2022.11.018
M3 - SCORING: Journal article
C2 - 36858660
VL - 16
SP - 415
EP - 425
JO - JACC-CARDIOVASC INTE
JF - JACC-CARDIOVASC INTE
SN - 1936-8798
IS - 4
ER -