A1 Refereed original research article in a scientific journal
Clinical Impact of Myocardium at Risk in Transcatheter Aortic Valve Implantation; 
Authors: Aurigemma, Cristina; Costa, Giuliano; Laterra, Giulia; Pilgrim, Thomas; Amat, Santos Ignacio J.; De Backer, Ole; Kim, Won-Keun; Barbosa, Ribeiro Henrique; Saia, Francesco; Bunc, Matjaz; Tchetche, Didier; Garot, Philippe; Ribichini, Flavio, Luciano; Mylotte, Darren; Watanabe, Yusuke; Bedogni, Francesco; Tesorio, Tullio; Rheude, Tobias; Sardella, Gennaro; Tocci, Marco; Franzone, Anna; Valvo, Roberto; Sammartino, Sofia; Savontaus, Mikko; Wienemann, Hendrik; Porto, Italo; Gandolfo, Caterina; Iadanza, Alessandro; Mach, Markus; Latib, Azeem; Biasco, Luigi; Taramasso, Maurizio; De Marco, Federico; Frittitta, Valentina; Dipietro, Elena; Reddavid, Claudia; Strazzieri, Orazio; Agnello, Federica; Comis, Alessandro; Calì, Mariachiara; Abdel-Wahab, Mohamed; Stefanini, Giulio Giuseppe; Tomii, Daijiro; Nuyens, Philippe; Sondergaard, Lars; Bortone, Alessandro S; Zimarino, Marco; Camara, Sergio F.; Palmerini, Tullio; Orzalkiewicz, Mateusz; Steblovnik, Klemen; Gautier, Alexandre; Del Sole, Paolo Alberto; Mainardi, Andrea; Lunardi, Mattia; Kawashima, Hideyuki; Criscione, Enrico; Cesario, Vincenzo; Biancari, Fausto; Zanin, Federico; Esposito, Giovanni; Adam, Matti; Grube, Eberhard; Baldus, Stephan; De Marzo, Vincenzo; Piredda, Elisa; Cannata, Stefano; Iacovelli, Fortunato; Andreas, Martin; Angellotti, Domenico; Sgroi, Carmelo; Xhepa, Erion; Kargoli, Faraj; Tamburino, Corrado; Burzotta, Francesco; Barbanti, Marco
Publisher: Ovid Technologies (Wolters Kluwer Health)
Publication year: 2026
Journal: Circulation: Cardiovascular Interventions
Volume: 19
Issue: 7
ISSN: 1941-7640
eISSN: 1941-7632
DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.125.015770
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Partially Open Access publication channel
Web address : https://doi.org/10.1161/circinterventions.125.015770
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/526825743
Self-archived copy's licence: CC BY
Self-archived copy's version: Publisher`s PDF
BACKGROUND:
The best management of coronary artery disease in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) is debated. We investigated the clinical impact of the residual extent of myocardium at risk in patients undergoing TAVI.
METHODS:Patients enrolled in the REVASC-TAVI (Management of Myocardial Revascularization in Patients Undergoing TAVI With Coronary Artery Disease) international multicenter registry were stratified according to the myocardium jeopardized by coronary artery disease using the British Cardiovascular Intervention Society Jeopardy Score (BCIS-JS) after a planned coronary revascularization. A planned revascularization included percutaneous coronary interventions performed before TAVI, during TAVI, or within 1 month after TAVI. The study population was divided according to the residual BCIS-JS (rBCIS-JS): patients with extensive residual myocardial at risk (rBCIS-JS >4 group) and patients without extensive residual myocardial at risk (rBCIS-JS ≤4 group). The primary study end point was the composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and rehospitalization for heart failure at 2 years.
RESULTS:Among the 2407 patients enrolled, 294 pairs of patients were selected by propensity matching and compared. At 2-year follow-up, the incidence of the primary end point was higher in patients with rBCIS-JS >4 compared with patients with rBCIS-JS ≤4 (37.5% versus 23.0%, P=0.004). A significantly lower rate of myocardial infarction was reported in patients with BCIS-JS ≤4 (8.2% versus 2.6%, P=0.011). At multivariate analysis, rBCIS-JS >4 (hazard ratio, 1.43 [95% CI, 1.11–1.84]; P=0.005) independently predicted 2-year major adverse cardiac and cerebrovascular events.
CONCLUSIONS:In patients with concomitant coronary artery disease and severe aortic stenosis, the residual myocardial risk significantly affects TAVI outcomes. In particular, a rBCIS-JS >4 is associated with higher rates of major adverse cardiac and cerebrovascular events at 2 years.
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