Adverse clinical outcomes in patients undergoing both PCI and TAVR: Analysis from a pooled multi‐center registry

Abstract

Background There is a paucity of data regarding the optimum timing of PCI in relation to TAVR. Objective We compared the major adverse cardiovascular and cerebrovascular events (MACCE) rates among patients who underwent percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) with those who received PCI with/after TAVR. Methods In this multicenter study, we pooled all consecutive patients who underwent TAVR at three high volume centers. Results Among 3,982 patients who underwent TAVR, 327 (8%) patients underwent PCI within 1 year before TAVR, 38 (1%) had PCI the same day as TAVR and 15 (0.5%) had PCI within 2 months after TAVR. Overall, among patients who received both PCI and TAVR (n = 380), history of previous CABG (HR:0.501; p = .001), higher BMI at TAVR (HR:0.970; p = .038), and statin therapy after TAVR (HR:0.660, p = .037) were independently associated with lower MACCE while warfarin therapy after TAVR was associated with a higher risk of MACCE (HR:1.779, p = .017). Patients who received PCI within 1 year before TAVR had similar baseline demographics, STS scores, clinical risk factors when compared to patients receiving PCI with/after TAVR. Both groups were similar in PCI (Syntax Score, ACC/AHA lesion class) and TAVR (valve types, access) related variables. There were no significant differences in terms of MACCE (log rank p = .550), all‐cause mortality (log rank p = .433), strokes (log rank p = .153), and repeat PCI (log rank p = .054) in patients who underwent PCI with/after TAVR when compared to patients who received PCI before TAVR. Conclusion Among patients who underwent both PCI and TAVR, history of CABG, higher BMI, and statin therapy had lower, while those discharged on warfarin, had higher adverse event rates. Adverse events rates were similar regardless of timing of PCI.

The impact of chronic total occlusions in patients undergoing transcatheter aortic valve replacement: A systematic review and meta‐analysis

“…Presently, revascularization is recommended in TAVR-patients with significant CAD, however there is a lack of evidence regarding the relevance and perfect timing of PCI in these patients since studies showed conflicting results. 15,40,41 Theoretically, CTO-revascularization before TAVR may prevent periprocedural myocardial infarction during rapid pacing for valve delivery. However, the revascularization procedure of the CTO is not without risk and patients may sustain serious complications during CTO PCI before TAVR.…”

Influence of coronary artery disease and percutaneous coronary intervention on mid‐term outcomes in patients with aortic valve stenosis treated with transcatheter aortic valve implantation

“…In their review, Cao et al included the timing of PCI in a flowchart of the strategy of CAD management in TAVI patients 20 . However, the recent article of Kumar et al demonstrated in a pooled multi‐center registry that the adverse events rate was similar whenever PCI was performed for patients who received TAVI 21 . There are many factors involved in this issue.…”

“… 20 However, the recent article of Kumar et al demonstrated in a pooled multi‐center registry that the adverse events rate was similar whenever PCI was performed for patients who received TAVI. 21 There are many factors involved in this issue. For example, all components of the anatomy and the severity of coronary artery stenosis and aortic valve stenosis have to be taken into consideration.…”

Pathophysiology, Diagnosis, and Treatment of Patients with Concomitant Severe Aortic Stenosis and Coronary Artery Disease: A Closer Look to the Unresolved Perplexity

“…Of note, the vast majority of patients were treated with balloon-expandable valves, which certainly imposes a limitation on results applicability. Similarly, in the US based registry in which 380 patients were treated with TAVI and PCI, the timing of PCI—either before or concomitant/after TAVI—had no impact on MACCE-free survival, and a propensity-matched analysis of 159 patients yielded similar results [ 83 , 84 ]. Yet, there was a significant discrepancy in terms of timing and number of patients, with 327 patients treated with PCI in the year before TAVI, 38 patients treated with concomitant TAVI and PCI and only 15 patients underwent PCI within two months post TAVI.…”