PCI in patients with severe aortic stenosis showed similar 30-day mortality compared to propensity-matched patients without aortic stenosis (4.3% vs 4.7%; HR 0.93; 95% CI 0.51-1.69; P=0.2).
Cohort (n=762)
Does percutaneous coronary intervention (PCI) increase 30-day mortality in patients with severe aortic stenosis compared to patients without aortic stenosis?
PCI can be performed in patients with severe symptomatic aortic stenosis without an increased risk of 30-day mortality compared to matched patients without AS, though risk is significantly higher in those with LVEF ≤30% or STS score ≥10.
Effect estimate: HR 0.93 (95% CI 0.51-1.69)
Absolute Event Rate: 4.3% vs 4.7%
p-value: p=0.2
BACKGROUND: With the availability of transcatheter aortic valve replacement, management of coronary artery disease in patients with severe aortic stenosis (AS) is posing challenges. Outcomes of percutaneous coronary intervention (PCI) in patients with severe AS and coronary artery disease remain unknown. We sought to compare the short-term outcomes of PCI in patients with and without AS. METHODS AND RESULTS: From our PCI database, we identified 254 patients with severe AS who underwent PCI between 1998 and 2008. Using propensity matching, we found 508 patients without AS who underwent PCI in the same period. The primary end point of 30-day mortality after PCI was similar in patients with and without severe AS (4.3% 11 of 254 versus 4.7% 24 of 508; hazard ratio, 0.93; 95% confidence interval, 0.51-1.69; P=0.2). Patients with low ejection fraction (≤30%) and severe AS had a higher 30-day post-PCI mortality compared with those with an ejection fraction >30% (5.4% 7 of 45 versus 1.2% 4 of 209; P<0.001). In addition, AS patients with high Society of Thoracic Surgeons score (≥10) had a higher 30-day post-PCI mortality than those with a Society of Thoracic Surgeons score <10 (10.4% 10 of 96 versus 0%; P<0.001). CONCLUSIONS: PCI can be performed in patients with severe symptomatic AS and coronary artery disease without an increased risk of short-term mortality compared with propensity-matched patients without AS. Patients with ejection fraction ≤30% and Society of Thoracic Surgeons score ≥10% are at a highest risk of 30-day mortality after PCI. This finding has significant implications in the management of severe coronary artery disease in high-risk severe symptomatic AS patients being considered for transcatheter aortic valve replacement.
Goel et al. (Fri,) conducted a cohort in Severe aortic stenosis and coronary artery disease (n=762). Percutaneous coronary intervention (PCI) vs. PCI in propensity-matched patients without aortic stenosis was evaluated on 30-day mortality after PCI (HR 0.93, 95% CI 0.51-1.69, p=0.2). PCI in patients with severe aortic stenosis showed similar 30-day mortality compared to propensity-matched patients without aortic stenosis (4.3% vs 4.7%; HR 0.93; 95% CI 0.51-1.69; P=0.2).