Outcomes in Patients With Transcatheter Aortic Valve Replacement and Left Main Stenting
Key result
TAVR plus LM PCI yields similar 1-year mortality to TAVR without LM revascularization.
- P=0.83
- n=256
Why the study?
Does TAVR plus LM PCI result in similar mortality compared to TAVR alone in patients with aortic stenosis?
Population
204 patients undergoing TAVR plus LM PCI and 1,188 control patients undergoing TAVR alone
Comparison
TAVR with pre-existing LM stents vs TAVR without LM revascularization
Design
Retrospective registry-based 1:1 matched case-control study
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
Supports feasibility of TAVR plus LM PCI in selected patients; leaves open need for randomized trials before practice change.
Key Points
- Evaluate clinical outcomes in patients undergoing TAVR plus left main PCI.
- Retrospective collection of clinical, echocardiographic, computed tomographic, and angiographic data in 204 patients.
- 1:1 case-control matching generated 128 matched pairs between patients with and without LM revascularization.
- Assessment of 30-day and 1-year mortality rates following interventions.
- One-year mortality rates were similar between TAVR plus LM PCI cohort and matched controls (9.4% vs. 10.2%, p = 0.83).
- Unplanned LM PCI showed significantly higher 30-day mortality (15.8% vs. 3.4%, p = 0.013) compared to planned LM PCI.
- At one year, mortality rates were 21.1% for unplanned versus 8.0% for planned LM PCI (p = 0.071).
Study Design
Type
Case-Control (n=256)
Structured PICO
Does TAVR plus LM PCI result in similar mortality compared to TAVR alone in patients with aortic stenosis?
P
Population
128 matched patient pairs comparing patients with pre-existing left main stents undergoing TAVR versus control patients undergoing TAVR without left main revascularization, followed for 1 year.
E
Exposure
Transcatheter aortic valve replacement (TAVR) plus percutaneous coronary intervention (PCI) of the left main coronary artery (LM)
C
Comparator
TAVR without LM revascularization (1:1 case-control matched)
O
Outcome
1-year mortalityhard clinical
Main Result
Absolute Event Rate: 9.4% vs 10.2%
p-value: p=0.83
TAVR combined with left main PCI is safe and feasible, yielding 1-year mortality rates comparable to TAVR alone in matched patients.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Chakravarty et al. (2016) conducted a case-control in Coexisting aortic stenosis and left main coronary artery disease (n=256). TAVR plus left main PCI vs. TAVR without left main revascularization was evaluated on 1-year mortality (p=0.83). TAVR plus left main PCI was associated with similar 1-year mortality compared to TAVR without left main revascularization (9.4% vs. 10.2%, p=0.83).