{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:17:38Z","timestamp":1791861458422,"version":"4.3.4"},"reference-count":32,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T00:00:00Z","timestamp":1728086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Montpellier University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Systematic revascularization of asymptomatic coronary artery stenosis before transcatheter aortic valve replacement (TAVR) is controversial. Purpose: The purpose of this study was to evaluate the feasibility and safety of functional evaluation of coronary artery disease (CAD) followed by selective ischemia-guided percutaneous coronary revascularization following TAVR. Methods: This prospective, bi-centric, single-arm, open-label trial included all patients with severe aortic stenosis (AS) eligible for TAVR and with significant CAD defined as \u22651 coronary stenosis \u2265 70%. Patients with left main stenosis \u2265 50%, proximal left anterior descending artery (LAD) stenosis \u2265 90% or &gt; class 2 Canadian Classification Society (CCS) angina were excluded. Myocardial ischemia was evaluated by stress cardiac imaging one month after TAVR. The primary endpoint was a composite of all-cause death, stroke, major bleeding (Bleeding Academic Research Consotium \u2265 3), major vascular complication (Valve Academic Research Consortium 3 criteria), acute coronary syndrome (ACS) and hospitalization for cardiac causes within 6 months of receiving TAVR. Results: Between June 2020 and June 2022, 64 patients were included in this study. The mean age was 84 \u00b1 5.2 years. CAD mostly involved LAD (n = 27, 42%) with frequent multivessel disease (n = 30, 47%) and calcified lesions (n = 39, 61%). Stress cardiac imaging could be achieved in 70% (n = 46) of the patients, while 30% (n = 18) did not attend the stress test. Significant myocardial ischemia was observed in only three patients (4.5%). At 6-month follow-up, fifteen patients (23%) reached the primary endpoint, including death in six patients (9%), stroke in three patients (5%) and major bleeding in three patients (5%). ACS was observed in only two patients (3%) but both had severe coronary stenosis (\u226590%) and did not refer for stress imaging for personal reasons. Hospital readmission (n = 27, 41%) was mostly related to non-cardiac causes (n = 17, 27%). Conclusions: In patients with asymptomatic CAD scheduled to undergo TAVR, a selective ischemia-guided coronary revascularization after TAVR seems to be safe, with a very low rate of ACS and few cases of myocardial ischemia requiring revascularization, despite low adherence to medical follow-up in this elderly population. This strategy could be evaluated in a randomized study.<\/jats:p>","DOI":"10.3390\/jcm13195932","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T07:30:18Z","timestamp":1728286218000},"page":"5932","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Feasibility and Safety of Post-Transcatheter Aortic Valve Replacement Coronary Revascularization Guided by Stress Cardiac Imaging"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5936-5184","authenticated-orcid":false,"given":"Florence","family":"Leclercq","sequence":"first","affiliation":[{"name":"Cardiology Department, Arnaud de Villeneuve University Hospital, University of Montpellier, 34293 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariama","family":"Akodad","sequence":"additional","affiliation":[{"name":"Cardiology Department, Arnaud de Villeneuve University Hospital, University of Montpellier, 34293 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4832-959X","authenticated-orcid":false,"given":"Elvira","family":"Prunet","sequence":"additional","affiliation":[{"name":"Cardiology Department, Caremeau University Hospital, Montpellier University, 30900 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabien","family":"Huet","sequence":"additional","affiliation":[{"name":"Cardiology Department, Arnaud de Villeneuve University Hospital, University of Montpellier, 34293 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Alain","family":"Meunier","sequence":"additional","affiliation":[{"name":"Cardiology Department, Arnaud de Villeneuve University Hospital, University of Montpellier, 34293 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Manna","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Medical Statistics and Public Health, Arnaud de Villeneuve University Hospital, 34090 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Christophe","family":"Macia","sequence":"additional","affiliation":[{"name":"Cardiology Department, Arnaud de Villeneuve University Hospital, University of Montpellier, 34293 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Robert","sequence":"additional","affiliation":[{"name":"Cardiology Department, Caremeau University Hospital, Montpellier University, 30900 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Steinecker","sequence":"additional","affiliation":[{"name":"Cardiology Department, Arnaud de Villeneuve University Hospital, University of Montpellier, 34293 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Berdeu","sequence":"additional","affiliation":[{"name":"Cardiology Department, Arnaud de Villeneuve University Hospital, University of Montpellier, 34293 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Schmutz","sequence":"additional","affiliation":[{"name":"Cardiology Department, Caremeau University Hospital, Montpellier University, 30900 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gandet","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Surgery, Arnaud de Villeneuve Hospital, 34090 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5288-9687","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"Roubille","sequence":"additional","affiliation":[{"name":"Cardiology Department, Arnaud de Villeneuve University Hospital, University of Montpellier, 34293 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6449-4826","authenticated-orcid":false,"given":"Guillaume","family":"Cayla","sequence":"additional","affiliation":[{"name":"Cardiology Department, Caremeau University Hospital, Montpellier University, 30900 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Mariano-Goulart","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital of Montpellier, 34295 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6167-500X","authenticated-orcid":false,"given":"Beno\u00eet","family":"Lattuca","sequence":"additional","affiliation":[{"name":"Cardiology Department, Caremeau University Hospital, Montpellier University, 30900 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/j.jacc.2012.10.049","article-title":"Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis","volume":"61","author":"Beach","year":"2013","journal-title":"J. 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