Key result
Following aortic valve replacement, an estimated 17% of patients require coronary access at 7 years, with higher rates observed in TAVR patients with a history of PCI or CAD.
Why the study?
Indications for TAVR have expanded to younger and low-risk patients, raising the question of coronary access for future PCI or coronary angiography following aortic valve replacement.
What is the incidence of needing coronary access for PCI or angiography following aortic valve replacement in Medicare patients?
Cohort (n=13,469)
Yes
What is the incidence of needing coronary access for PCI or angiography following aortic valve replacement in Medicare patients?
A substantial portion of AVR patients, particularly those with a history of CAD or prior PCI undergoing TAVR, require future coronary access, emphasizing the need to consider future coronary access during initial valve selection.
May warrant attention to future coronary access in TAVR planning for CAD patients; leaves open whether this alters valve selection.
The aim of the study was to estimate the percentage of Medicare patients needing coronary access for percutaneous coronary intervention (PCI) or coronary angiography following aortic valve replacement (AVR). Indications for TAVR have expanded to include younger and low-risk patients, raising the question of coronary access for future procedures. Medicare patients <80 years old with an AVR between 2011 and 2018 were included. Time-to-event analyses were conducted using Cox hazard models to estimate risk of coronary access up to 7 years after AVR. Model adjustments included age, sex, race, region, comorbidity, concomitant CABG, and smoking. A total of 13,469 Medicare patients (mean age 70.6) met inclusion criteria. Models estimated that 2.5% of patients at 1-year post-index and 17% at over 7 years would need coronary access. For patients who had SAVR (with or without CABG), estimates for coronary access were similar and over 15% after 6.5 years. For TAVR patients, with a previous PCI, 28% at 4.5 years required coronary access, which was higher than TAVR patients without a previous PCI. SAVR patients with and without CAD at baseline were similar; however, TAVR patients with CAD had a 22% rate of coronary access versus 7% for those without at 3 years. Approximately half of patients who needed coronary access returned to the same hospital as their initial AVR. Coronary access is required in a substantial portion of AVR patients especially those with PCI or a history of CAD undergoing TAVR. The need for coronary access may increase as transcatheter AVR becomes accessible to younger patients with a longer life expectancy.
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Hermiller et al. (2021) conducted a cohort in Aortic valve replacement (n=13,469). Aortic valve replacement (AVR) was evaluated on Need for coronary access for percutaneous coronary intervention (PCI) or coronary angiography. Following aortic valve replacement, an estimated 17% of patients require coronary access at 7 years, with higher rates observed in TAVR patients with a history of PCI or CAD.
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