Key result
In patients with severe aortic stenosis and coexisting coronary artery disease, performing PCI alongside TAVI resulted in a similar 30-day composite safety endpoint compared to isolated TAVI (13% vs 21%, p=0.67) while significantly reducing ischemic burden.
Why the study?
Does percutaneous coronary intervention improve ischemic burden and 30-day clinical outcomes in patients with significant coronary artery disease undergoing TAVI?
Observational (n=120)
No
Does percutaneous coronary intervention improve ischemic burden and 30-day clinical outcomes in patients with significant coronary artery disease undergoing TAVI?
Absolute Event Rate: 13% vs 21%
p-value: p=0.67
In patients with significant coronary artery disease undergoing TAVI, concomitant PCI can be performed safely and significantly reduces ischemic burden without compromising 30-day clinical outcomes.
May support concomitant PCI in TAVI with CAD; hypothesis-generating and requires randomized confirmation.
Objective : Coronary artery disease ( CAD ) frequently coexists with aortic stenosis ( AS ). During surgical aortic valve replacement, concomitant coronary artery bypass grafting is recommended in patients with significant CAD. However, the management of CAD in patients undergoing transcatheter aortic valve implantation ( TAVI ) is undetermined. Materials and Methods : We analyzed 120 consecutive patients who underwent TAVI between April 2010 and February 2015 in our hospital. Significant CAD was defined as unrevascularized significant coronary artery stenosis. Results : Of 120 patients, 34 ( 28% ) had significant CAD. Thirty-day outcomes were similar between patients with CAD and those without CAD. Among 34 patients with CAD, 15 ( 44% ) underwent percutaneous coronary intervention ( PCI ). PCI was performed safely, except one case of coronary dissection necessitating additional coronary stenting. The clinical outcomes at 30 day were the same in TAVI+PCI group and isolated TAVI group. Ischemic burden evaluated by SYNYAX score ( SS ) and Duke Myocardial Jeopardy Score ( DMJS ) were significantly alleviated by PCI ( SS : 7.2 ± 2.9 vs 0.5 ± 1.1, p < 0.01. DMJS : 5.3 ± 2.8 vs 0.4 ± 0.8, p < 0.01 ). Conclusion : Significant CAD was found in 28% of patients undergoing TAVI. PCI can be performed safely, and significantly alleviates the ischemic burden of CAD.
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Higuchi et al. (2015) conducted an observational in Severe aortic stenosis with coexisting coronary artery disease (n=120). Percutaneous coronary intervention (PCI) vs. Isolated TAVI (no PCI) was evaluated on 30-day composite safety endpoint (p=0.67). In patients with severe aortic stenosis and coexisting coronary artery disease, performing PCI alongside TAVI resulted in a similar 30-day composite safety endpoint compared to isolated TAVI (13% vs 21%, p=0.67) while significantly reducing ischemic burden.
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