Key result
Concomitant TAVI and complex PCI matches staged procedures for primary outcomes but links to ~48% more secondary events.
Why the study?
Evidence is lacking to guide treatment and PCI timing strategies in patients with a concomitant indication for TAVI and complex, high-risk PCI.
Does concomitant TAVI and complex/high-risk PCI improve outcomes compared to a staged approach in patients with severe aortic stenosis?
Cohort (n=519)
Does concomitant TAVI and complex/high-risk PCI improve outcomes compared to a staged approach in patients with severe aortic stenosis?
In patients requiring both TAVI and complex/high-risk PCI, a staged approach may be preferable as concomitant procedures are associated with higher rates of procedural adverse events.
Answers are grounded in this paper and cite their sources.
May favor staging to limit secondary events with complex PCI during TAVI; leaves open need for randomized confirmation.
BACKGROUND: There is a lack of evidence to guide treatment of patients with a concomitant indication for transcatheter aortic valve implantation (TAVI) and complex, high-risk percutaneous coronary intervention (PCI). AIMS: We aimed to assess different strategies of PCI timing in this high-risk TAVI cohort. METHODS: The ASCoP registry retrospectively included patients with a clinical indication for both TAVI and PCI with at least 1 criterion of complex or high-risk PCI. The primary endpoint was a composite of all-cause death and unplanned rehospitalisation for cardiovascular causes. The secondary endpoint was a composite of all-cause death, stroke, acute myocardial infarction, major bleeding, major vascular complication and unplanned revascularisation. Multivariable analysis was used to adjust for possible confounders. RESULTS: A total of 519 patients were included: 363 (69.9%) underwent staged procedures and 156 (30.1%) concomitant TAVI and PCI. After 441 (interquartile range 182-824) days, the primary endpoint occurred in 151 (36.5%) cases, without any significant difference between the 2 groups (p=0.98), while the secondary endpoint occurred more frequently in the concomitant group (n=36 [25.8%] vs n=57 [17.4%]; p=0.014). CONCLUSIONS: In patients undergoing TAVI and complex/high-risk PCI, a concomitant strategy is associated with a higher rate of adverse events and increased procedural risk. (ClinicalTrials.gov: NCT05750927).
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Montalto et al. (2025) conducted a cohort in Severe aortic stenosis with concomitant indication for TAVI and complex, high-risk PCI (n=519). Concomitant TAVI and PCI vs. Staged TAVI and PCI was evaluated on Composite of all-cause death and unplanned rehospitalisation for cardiovascular causes (p=0.98). Concomitant TAVI and complex/high-risk PCI yielded similar primary outcomes to staged procedures (p=0.98) but increased secondary adverse events (25.8% vs 17.4%; p=0.014).
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