Journal Article

Residual SYNTAX score and outcomes after TAVR+PCI versus SAVR+CABG: a propensity-matched, gender-based comparison

Rudolph, Volker, Horn, Isabel, Höflsauer, Katharina, Kirchner, Johannes, Scholtz, Smita, Fortmeier, Vera, Gummert, Jan, Davidson, Charles J, Bleiziffer, Sabine, Gerçek, Muhammed, El Hachem, Georges, Rudolph, Tanja K, Potratz, Max

2025

Overview

BackgroundAortic stenosis (AS) and coronary artery disease (CAD) frequently coexist, requiring careful revascularisation strategy consideration. While surgical aortic valve replacement (SAVR) plus coronary artery bypass grafting (CABG) is traditional, transcatheter aortic valve replacement (TAVR) plus percutaneous coronary intervention (PCI) is increasingly used. The optimal strategy, particularly regarding residual CAD burden, remains unclear.ObjectivesThis study investigated the impact of residual SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score (rSS) on outcomes in men and women with AS and CAD undergoing TAVR+PCI versus SAVR+CABG.MethodsIn this retrospective study, propensity score-matched cohorts of men and women undergoing either procedure were analysed. Matching variables included age, left ventricular ejection fraction, EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) and CAD severity.Results398 patients (114 women and 284 men) were included. The rSS was predictive of the primary composite endpoint in the TAVR+PCI group (p=0.006 women and p<0.001 men) but not in the SAVR+CABG group. In patients achieving an rSS<8, TAVR+PCI was associated with a lower combined endpoint rate compared with SAVR+CABG, consistent across genders (p=0.02). Furthermore, TAVR+PCI demonstrated significant safety benefits, including lower rates of major bleeding in men (2.1% vs 10.6%) and stroke in women (1.8% vs 12.3%).ConclusionsThe prognostic importance of the rSS is strategy-dependent. For patients undergoing TAVR+PCI, achieving extensive revascularisation (rSS <8) is a critical procedural goal associated with improved outcomes. For patients undergoing SAVR+CABG, prognosis appears driven more by baseline clinical risk.

• Publisher: British Cardiovascular Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Aged / Aged, 80 and over / Angioplasty / Aortic stenosis / Aortic Valve - diagnostic imaging / Aortic Valve - surgery / Aortic Valve Stenosis / Aortic Valve Stenosis - complications / Aortic Valve Stenosis - diagnosis / Aortic Valve Stenosis - mortality / Aortic Valve Stenosis - surgery / Cardiovascular disease / Coronary Artery Bypass / Coronary Artery Bypass - adverse effects / Coronary Artery Bypass - mortality / Coronary artery disease / Coronary Artery Disease - complications / Coronary Artery Disease - diagnosis / Coronary Artery Disease - mortality / Coronary Artery Disease - surgery / Coronary vessels / Diabetes / Female / Follow-Up Studies / Gender / Heart surgery / Heart Valve Prosthesis / Heart Valve Prosthesis Implantation / Heart Valve Prosthesis Implantation - adverse effects / Humans / Male / Patients / Percutaneous Coronary Intervention - adverse effects / Percutaneous Coronary Intervention - mortality / Propensity Score / Regression analysis / Retrospective Studies / Risk Assessment / Risk Factors / Severity of Illness Index / Sex Factors / Transcatheter Aortic Valve Replacement / Transcatheter Aortic Valve Replacement - adverse effects / Transcatheter Aortic Valve Replacement - mortality / Treatment Outcome / Variables / Vein & artery diseases / Women