BACKGROUND Scarce data exist on coronary events following transcatheter aortic valve replacement (TAVR), and no study has determined the factors associated with poorer outcomes in this setting. This study sought to determine the clinical characteristics, outcomes, and prognostic factors of acute coronary syndrome (ACS) events following TAVR. METHODS Multicenter cohort study including a total of 270 patients presenting an ACS after a median time of 12 (interquartile range, 5-17) months post-TAVR. Post-ACS death, myocardial infarction, stroke, and overall major adverse cardiovascular or cerebrovascular events were recorded. RESULTS The ACS clinical presentation consisted of non-ST-segment-elevation myocardial infarction (STEMI) type 2 (31.9%), non-STEMI type 1 (31.5%), unstable angina (28.5%), and STEMI (8.1%). An invasive strategy was used in 163 patients (60.4%), and a percutaneous coronary intervention was performed in 97 patients (35.9%). Coronary access issues were observed in 2.5% and 2.1% of coronary angiography and percutaneous coronary intervention procedures, respectively. The in-hospital mortality rate was 10.0%, and at a median follow-up of 17 (interquartile range, 5-32) months, the rates of death, stroke, myocardial infarction, and major adverse cardiovascular or cerebrovascular events were 43.0%, 4.1%, 15.2%, and 52.6%, respectively. By multivariable analysis, revascularization at ACS time was associated with a reduction of the risk of all-cause death (hazard ratio, 0.54 [95% CI, 0.36-0.81] P=0.003), whereas STEMI increased the risk of all-cause death (hazard ratio, 2.06 [95% CI, 1.05-4.03] P=0.036) and major adverse cardiovascular or cerebrovascular events (hazard ratio, 1.97 [95% CI, 1.08-3.57] P=0.026). CONCLUSIONS ACS events in TAVR recipients exhibited specific characteristics (ACS presentation, low use of invasive procedures, coronary access issues) and were associated with a poor prognosis, with a very high in-hospital and late death rate. STEMI and the lack of coronary revascularization determined an increased risk. These results should inform future studies to improve both the prevention and management of ACS post-TAVR.

中文翻译：

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经导管主动脉瓣置换术后的急性冠脉综合征。

背景技术经导管主动脉瓣置换术（TAVR）后发生冠脉事件的数据稀少，并且尚无研究确定与这种情况下预后差相关的因素。这项研究试图确定TAVR后急性冠脉综合征（ACS）事件的临床特征，结局和预后因素。方法多中心队列研究包括总共270名在TAVR后12个月（中位数范围为5至17个月）中位时间后出现ACS的患者。记录ACS后死亡，心肌梗塞，中风和总体主要不良心血管或脑血管事件。结果ACS临床表现包括2型非ST段抬高型心肌梗塞（STEMI）（31.9％），1型非STEMI心肌梗塞（31.5％），不稳定型心绞痛（28.5％）和STEMI（8.1％）。163例患者（60.4％）采用了侵入性治疗策略，而97例患者（35.9％）采用了经皮冠状动脉介入治疗。分别在2.5％和2.1％的冠状动脉造影和经皮冠状动脉介入手术中观察到了冠状动脉进入问题。院内死亡率为10.0％，在中位随访17（四分位间距为5-32）个月时，死亡率，中风，心肌梗塞和主要不良心血管或脑血管事件的发生率为43.0％，分别为4.1％，15.2％和52.6％。通过多变量分析，ACS时的血运重建与全因死亡风险降低相关（危险比，0.54 [95％CI，0.36-0.81] P = 0.003），而STEMI增加全因死亡风险（危险比，2.06 [95％CI，1.05-4.03] P = 0。036）和严重的不良心血管或脑血管事件（危险比，1.97 [95％CI，1.08-3.57] P = 0.026）。结论TAVR接受者的ACS事件表现出特定特征（ACS表现，侵入性手术使用率低，冠状动脉介入问题），并且预后不良，院内和晚期死亡率很高。STEMI和冠状动脉血运重建的缺乏确定了增加的风险。这些结果应为将来的研究提供参考，以改善TAVR后ACS的预防和管理。STEMI和冠状动脉血运重建的缺乏确定了增加的风险。这些结果应为将来的研究提供参考，以改善TAVR后ACS的预防和管理。STEMI和冠状动脉血运重建的缺乏确定了增加的风险。这些结果应为将来的研究提供参考，以改善TAVR后ACS的预防和管理。