Background:  Coronary angiography (CA) and percutaneous coronary intervention (PCI) after transcatheter aortic valve implantation (TAVI) may be challenging due to impaired coronary access. Particularly in acute clinical settings, a delayed or failed selective coronary engagement could have deleterious consequences. The aim of the present study was to determine the feasibility of urgent CA and PCI in patients after TAVI.

Methods: This retrospective, international, multicenter registry (AMITAVI – Acute Myocardial Infarction after TranscatheterAortic Valve Implantation) collected data of patients with prior TAVI requiring urgent or emergent CA for acute coronary syndromes (ST-elevation myocardial infarction [STEMI] and NSTE-ACS comprising non-ST-elevation myocardial infarction [NSTEMI] or unstable angina pectoris [UAP]) or other acute cardiovascular situations. The primary outcome measure was the feasibility of CA. Secondary outcome measures were 30-day all-cause mortality and the success of PCI.

Results: A total of 449 patients (81.3 [IQR 77.0-85.0] years, 40.1% female) from 25 sites with STEMI (9.1%), NSTE-ACS (79.1%), and other indications for CA (10.9%) were included. Success rates were high for CA of the RCA (98.3%) and LCA (99.3%) and were higher among patients with short stent-frame prostheses (SFPs) than in those with long SFPs for CA of the RCA (99.6% vs. 95.9%; p=0.005), but not for CA of the LCA (99.7% vs. 98.7%; p=0.24). Unselective coronary engagement was less common in the short SFP group for both the RCA (18.3% vs. 50.7%; p<0.001) and the LCA (12.4% vs. 36.5%; p<0.001). Technical success of PCI for native coronary arteries was high (91.4%) and independent from valve type (short 90.4% vs. long 93.4% SFP; p=0.44). Guide engagement failed in 6 cases, resulting in emergent coronary artery bypass grafting (CABG; n=3) and in-hospital death (n=3). Independent predictors of 30-day all-cause mortality were prior diabetes and cardiogenic shock, but not valve type or success of coronary engagement.