Incidence, Predictors, and Mortality of Acute Coronary Syndrome after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Transcatheter aortic valve replacement (TAVR) is a crucial intervention for patients with severe aortic stenosis. There is limited data regarding the occurrence of coronary events post-TAVR and the adverse outcomes. This study aimed to establish the prevalence, mortality rate, and predictive factors of acute coronary syndrome (ACS) post-TAVR. A systematic literature search was conducted via PubMed, SCOPUS, and Ovid SP to retrieve studies reporting the incidence of ACS following TAVR. Pooled incidence and pooled odds ratios (ORs) were calculated using the generic inverse variance method. A total of 10 studies involving 462,060 patients underwent TAVR and 11,402 patients diagnosed with ACS following TAVR were included in this meta-analysis. The incidence of ACS following TAVR was 1.9% [95% confidence interval (CI): 0.8-4.2%]. Further analysis demonstrated that the incidence of ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina was 8.9% (95% CI: 5.2-14.7%), 77.6% (95% CI: 59.0-89.3%), and 18.0% (95% CI: 2.6-63.8%), respectively. Notably, 33.5% (95% CI 13.1-62.8%) of the patients were managed with percutaneous coronary intervention. The mortality rate was 11.1% (95% CI: 7.1-17.2%). History of percutaneous coronary intervention (OR: 1.48, 95% CI: 1.31-1.67) and diabetes (OR: 1.21, 95% CI: 1.03-1.43) were predictors of development of ACS after TAVR. The incidence of ACS in post-TAVR patients is low but is associated with a significant mortality rate.