Investigation of coronary artery disease and its effect on cardiovascular events in patients undergoing transcatheter aortic valve implantation

Objective: To investigate the impact of the selective coronary angiography strategy on outcomes such as all-cause mortality and cardiovascular mortality in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Materials and Methods: TAVI procedures performed in our clinic between 2017 and 2024 were retrospectively analyzed. Patients who underwent invasive coronary angiography either simultaneously or before the procedure were compared with those who did not undergo coronary angiography (CAG). Results: A significant difference was found in all-cause mortality between the CAG and non-CAG groups (32.1% vs. 47.4%, p=0.004), while no significant difference was observed in cardiovascular mortality (12% vs. 14%, p=0.350). Patients in the CAG group had more comorbidities, a higher prevalence of diagnosed coronary artery disease, and associated coronary artery risk factors (history of myocardial infarction: 20.5% vs. 10.5%, p=0.013; diabetes mellitus: 54.5% vs. 39.3%, p=0.006; age: 78.5±8 vs. 84.1±7.4, p<0.001). Conclusion: It is known that selective invasive coronary angiography after TAVI can be challenging. However, our study suggests that rather than a routine pre- procedural coronary angiography approach or the opposite, a patient-based decision- making process and operator preference do not create a significant difference in cardiovascular mortality. Moreover, this approach could help reduce healthcare costs and procedure-related complications.