Key result
In patients undergoing TAVI, the addition of PCI for coronary artery disease resulted in an all-cause mortality of 10.2% compared to 5.6% for TAVI alone, without reaching statistical significance.
Why the study?
Does TAVI combined with PCI improve outcomes compared to TAVI alone in high-risk patients with aortic stenosis and concomitant CAD?
Does TAVI combined with PCI improve outcomes compared to TAVI alone in high-risk patients with aortic stenosis and concomitant CAD?
Absolute Event Rate: 10.2% vs 5.6%
p-value: p=NS
Staged or concomitant PCI with TAVI in patients with aortic stenosis and CAD appears feasible with comparable safety endpoints to TAVI alone, though the optimal strategy requires further investigation in larger cohorts.
More than 50% of the 240 patients referred for TAVI had CAD with primarily advanced stages of disease. Most of the patients have already been treated either with PCI or CABG before TAVI. Surprisingly CAD was firstly detected during TAVI evaluation in almost one-third of the patients, whereas the necessity to treat CAD by PCI was limited to only eleven (17%) patients. Despite the higher risk profile of patients with AS and concomitant CAD, the mortality rate at 30 days and follow-up of 248±239 days did not differ respectively. In the study by Wenaweser and Pilgrim, almost two-thirds of the 256 patients had CAD 6 . In contrast to Gautier et al, 35% of the pati- ents received CAD treatment by PCI, 23 patients as staged and 36 patients as concomitant procedure. The DUKE jeopardy score to assess myocardium at risk and the SYNTAX score were used to guide CAD treatment strategy via PCI. There was no significant difference with regard to the VARC safety endpoints between the TAVI and the TAVI+PCI group, as well as for the staged and conco- mitant approach. It has to be underlined that all cause mortality in the PCI group was almost double compared to the TAVI group (10.2% vs. 5.6%) without reaching the level of significance, most likely due to the limited patient number. In this paper, the low rates of significant renal failure stage 3 according to the RIFLE criteria is noticeable given the relatively high amounts of contrast medium used in all groups. Even if the SYNTAX score was comparable, 330±140 mL of contrast medium were used only for PCI in the staged intervention group. It appears that more complex procedures were possibly performed at two different time points. Another inter- pretation might be the operator-dependent cautious use of contrast medium during a concomitant approach.
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Woitek et al. (2011) conducted an editorial in Aortic stenosis and coronary artery disease. PCI (staged or concomitant) with TAVI vs. TAVI alone was evaluated on All-cause mortality (p=NS). In patients undergoing TAVI, the addition of PCI for coronary artery disease resulted in an all-cause mortality of 10.2% compared to 5.6% for TAVI alone, without reaching statistical significance.
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