Impact of Coronary Artery Disease and Percutaneous Coronary Intervention on Transcatheter Aortic Valve Implantation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease in patients undergoing transcatheter aortic valve implantation (TAVI) (n=1030). Intervention: Concomitant coronary artery disease (CAD) and/or preoperative percutaneous coronary intervention (PCI) vs. No CAD and/or no PCI. Primary outcome: In-hospital adverse clinical outcomes (including death, stroke, bleeding, vascular complications, pacemaker implantation, and acute kidney injury).

Anthony Matta; Thibault Lhermusier; Francisco Campelo Parada; Frédéric Bouisset; Ronan Canitrot; Vanessa Nader; Stéphanie Blanco; Meyer Elbaz; Jérôme Roncalli; Didier Carrié

doi:10.1155/2021/6672400

March 24, 2021Journal of Interventional CardiologyOpen Access

Impact of Coronary Artery Disease and Percutaneous Coronary Intervention on Transcatheter Aortic Valve Implantation

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Key result

Concomitant coronary artery disease and/or preoperative percutaneous coronary intervention did not significantly increase the risk of in-hospital death or adverse clinical outcomes post-TAVI.

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Why the study?

Prevalence of CAD detected before TAVI is high, but the management of concomitant CAD remains unclear.

Does the presence of concomitant coronary artery disease or preoperative percutaneous coronary intervention increase in-hospital adverse outcomes in patients undergoing transcatheter aortic valve implantation?

Study Design

Type

Cohort (n=1,030)

Multicenter

No

Structured PICO

Does the presence of concomitant coronary artery disease or preoperative percutaneous coronary intervention increase in-hospital adverse outcomes in patients undergoing transcatheter aortic valve implantation?

P

Population

1,030 patients undergoing transcatheter aortic valve implantation evaluated for the impact of concomitant coronary artery disease and percutaneous coronary intervention on in-hospital outcomes.

E

Exposure

Presence of concomitant coronary artery disease (CAD) and/or preoperative percutaneous coronary intervention (PCI)

C

Comparator

No concomitant CAD or no preoperative PCI

O

Outcome

In-hospital adverse clinical outcomes including death, stroke, major or life-threatening bleeding, minor bleeding, major vascular complications, minor vascular complications, pacemaker implantation, and acute kidney injuryhard clinical

The presence of concomitant coronary artery disease or the performance of preoperative PCI does not negatively impact in-hospital clinical outcomes following TAVI.

Implication

CAD or pre-TAVI PCI showed no short-term harm; leaves open optimal management strategies pending prospective trials.

Abstract

Introduction. The prevalence of coronary artery disease (CAD) detected in preoperative work-up for transcatheter aortic valve implantation (TAVI) is high. Instead, the management of a concomitant CAD remains unclear. We evaluate the impact of CAD and percutaneous coronary intervention (PCI) on TAVI procedures. Materials and Methods. A retrospective study was conducted on 1336 consecutive patients who underwent TAVI in Toulouse University Hospital, Rangueil, France. The studied population was divided into 2 groups: CAD-TAVI group and No CAD-TAVI group. Then, the CAD-TAVI group was segregated into 2 subgroups: PCI-TAVI group and No PCI-TAVI group. In-hospital adverse clinical outcomes were assessed in each group. Results. Pre-TAVI work-up revealed significant CAD in 36% of 1030 patients eligible for inclusion in the study. The overall prevalence of in-hospital death, stroke, major or life-threatening bleeding, minor bleeding, major vascular complications, minor vascular complications, pacemaker implantation, and acute kidney injury was 2.7%, 2.4%, 2.8%, 3.6%, 3.9%, 7.5%, 12.5%, and 2.7%, respectively. Among the studied population, 55% were admitted to the cardiac care unit. No significant statistical difference was observed between groups. Discussion. CAD-TAVI population was not more likely to develop in-hospital adverse clinical outcomes post-TAVI procedure compared to others. Also, no significant difference regarding in-hospital death was observed. In parallel, performing PCI prior to TAVI did not increase the risk of in-hospital death and complications. The difference in terms of the distribution of antithrombotic regimen may explain the higher prevalence of bleeding events in the PCI-TAVI group. Conclusion. This study provides direct clinical relevance useful in daily practice. No negative impact has been attributed to the presence of a concomitant CAD and/or preoperative PCI on the TAVI hospitalization period.

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Cite This Study

Matta et al. (2021) conducted a cohort in Coronary artery disease in patients undergoing transcatheter aortic valve implantation (TAVI) (n=1,030). Concomitant coronary artery disease (CAD) and/or preoperative percutaneous coronary intervention (PCI) vs. No CAD and/or no PCI was evaluated on In-hospital adverse clinical outcomes (including death, stroke, bleeding, vascular complications, pacemaker implantation, and acute kidney injury). Concomitant coronary artery disease and/or preoperative percutaneous coronary intervention did not significantly increase the risk of in-hospital death or adverse clinical outcomes post-TAVI.

synapsesocial.com/papers/6a7b98e82305edf9bbed179f https://doi.org/10.1155/2021/6672400