The coexistence of severe aortic stenosis (AS) and coronary artery disease (CAD) among patients eligible for TAVR is frequent. However, data regarding its prevalence and management are inconsistent and controversial. The objective of this study is to determine the prevalence and predictors of CAD in patients undergoing TAVR.

Methods and results: we performed a retrospective, single-center cohort study, including patients with symptomatic severe AS treated by TAVR in a university hospital from Argentina between 2015 and 2022. The primary objective was to describe the prevalence and predictors of significant CAD. In order to describe the severity of CAD, patients were classified into four groups: 1) non-obstructive (no significant stenosis), 2) intermediate risk (significant stenosis in one epicardial vessel -excluding lesions in proximal left anterior descending artery-), 3) high risk (significant stenosis in two epicardial vessels or in proximal left anterior descending artery or left coronary artery stenosis ≥50% but <70%) and 4) extreme risk (significant stenosis in 3 epicardial vessels or stenosis ≥70% in the left coronary artery). 

Data are reported as median and interquartile range [IQR] or number and percentage (%). A multivariate logistic regression was performed including clinically relevant variables to assess predictors of CAD. 

A total of 333 patients underwent TAVR during the period analyzed, we excluded 61 (18.3%) patients with previously known CAD and 59 (17.7%) without pre-TAVR coronary angiogram. 

We included 213 patients, 137 (64%) were women. The median age was 84 [79-88] years old. As regards cardiovascular risk factors, 185 (87%) of the patients had hypertension, 164 (77%) had dyslipemia, 114 (54%) had chronic kidney disease and 38 (18%) were diabetic. History of previous stroke and peripheral artery disease was observed in 20 (9%) and 29 (14%) patients, respectively. The median STS was 4.2% [2.6-6.6] %.

Among patients with pre-TAVR coronary angiogram, 151 (71%) presented with nonobstructive CAD, while 62 (29%) had at least one significant stenosis in ≥ 1 epicardial vessel. Regarding CAD severity, 41 (66%), 17 (28%) and 4 (6%) patients presented intermediate, high, and extreme risk CAD, respectively. 

In the multivariate logistic regression model, only male gender was identified as an independent predictor of significant CAD, even after adjusting for age, diabetes, dyslipidemia, chronic kidney disease and previous stroke or peripheral artery disease (OR 2.26 [1.21-4.22], p= 0.01).

Among patients with significant CAD, angioplasty was performed in 34 of 62 (55%) of them. Patients with more severe CAD were more likely to receive angioplasty (4 (100%) patients with extreme-risk, 12 (70%) patients with high-risk, and 18 (44%) patients with intermediate-risk, p=0.031). 

Conclusions: Among patients who underwent TAVR without prior CAD, 29% were diagnosed with significant CAD during pre-TAVR coronary angiogram. Additionally, male gender emerged as an independent predictor of significant CAD.