Gontijo-Santos Lima, S.M. (2021) Feasibility of QFR assessment of coronary lesions requiring Percutaneous Coronary Intervention and bleeding complications post-transcatheter aortic valve implantation: a retrospective analysis. thesis, UNSPECIFIED.
Full text available on request.Abstract
Introduction: Coronary Artery Disease (CAD) and Aortic Stenosis (AS) frequently co-exist in heart patients, requiring a Percutaneous Coronary Intervention (PCI) and a Transcatheter Aortic Valve Replacement (TAVR). A PCI, normally done pre-TAVR, requires anticoagulation treatment, which can increase the bleeding complications during and after the valve replacement procedure. A new, non-invasive technique called Quantitative Flow Ratio (QFR) measures the percentage of stenosis of the coronary arteries, giving interventionist cardiologists an indication whether to revascularize a coronary artery or not. Methods: A total of 267 patients that underwent TAVR in the UMCG since 2009 were followed up. This data was used to do a retrospective and explorative analysis on the complications post-TAVR, especially Major Adverse Cardiovascular Events (MACE) and bleedings according to BARC score. Also, Coronary Angiograms (CAG’s) were analyzed and QFR measurements of 25 coronary arteries were done using the software Medis Suite. Results: Patients undergoing TAVR who had CAD, had undergone PCI in the past or had undergone PCI within 3 months pre-TAVR, all used more anticoagulants than the control group. There was an increased bleeding incidence in patients who did not undergo PCI pre-TAVR. Because these patients use more coumarin compared to the PCI group, bleeding could be explained due to dysregulated INR. PCI, regardless of the time pre-TAVR is a risk factor for an increase hospitalization for cardiac causes after 30 days of the procedure. 48% of PCI were done in coronary arteries with a QFR>0.75, therefore with no indication. Conclusion: CAD or PCI pre-TAVR does not influence MACE or NACE outcomes compared to control groups. PCI, regardless of the time pre-TAVR, increases hospitalization for cardiac causes after 30 days. Coumarin use in patients with no CAD increases the bleeding risks, possibly due to unregulated INR. Better quality CAG images must be provided without a stent and with 25 degrees apart for accurate QFR measurements.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Voors, prof. dr. A.A. and Wykrzykowska, dr. J.J. |
| Faculty: | Medical Sciences |
| Date Deposited: | 07 Jan 2022 10:33 |
| Last Modified: | 07 Jan 2022 10:33 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2998 |
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