Long-term outcomes of concomitant transcatheter aortic valve implantation and percutaneous coronary intervention

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: severe aortic stenosis and coronary artery disease (n=786). Intervention: TAVI and concomitant PCI vs. TAVI alone. Primary outcome: all-cause death at 3 years (p=0.615).

Q: What does this research mean for the field?

Concomitant transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) provides comparable long-term safety and effectiveness up to 3 years compared to TAVI alone in patients with severe aortic stenosis and coronary artery disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Roberto Valvo; Giuliano Costa; Enrico Criscione; Claudia Reddavid; Orazio Strazzieri; S. Motta; Elena Dipietro; Valentina Frittitta; Gabriele Carciotto; Carmelo Mignosa; Carmelo Sgroi; Corrado Tamburino; Marco Barbanti

doi:10.23736/s2724-5683.22.06025-2

October 28, 2022Minerva Cardiology and Angiology

Long-term outcomes of concomitant transcatheter aortic valve implantation and percutaneous coronary intervention

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Key result

Concomitant TAVI and PCI shows no benefit over TAVI alone for 3-year mortality.

P=0.615
n=786

Why the study?

The safety of concomitant PCI during TAVI remains highly debated.

Does concomitant PCI during TAVI improve or worsen outcomes compared to TAVI alone in patients with severe aortic stenosis and CAD?

Study Design

Type

Cohort (n=786)

Structured PICO

Does concomitant PCI during TAVI improve or worsen outcomes compared to TAVI alone in patients with severe aortic stenosis and CAD?

P

Population

786 patients with severe aortic stenosis and coronary artery disease who underwent TAVI, with 302 propensity-matched to compare TAVI alone versus TAVI with concomitant PCI up to 3 years.

E

Exposure

Transcatheter aortic valve implantation (TAVI) and concomitant percutaneous coronary intervention (PCI) performed in the same session

C

Comparator

TAVI alone

O

Outcome

In-hospital death, stroke, myocardial infarction (MI), major and life-threatening bleeding, and acute kidney injury; and 3-year all-cause death, composite of all-cause death and MI, and composite of all-cause death, MI, and strokehard clinical

Main Result

Absolute Event Rate: 19.2% vs 25.2%

p-value: p=0.615

Concomitant TAVI and PCI in the same session appears as safe and effective as TAVI alone up to 3 years in patients with severe aortic stenosis and CAD.

Implication

Concomitant PCI during TAVI was associated with comparable safety; leaves open optimal timing pending randomized data.

Abstract

BACKGROUND: The safety of concomitant percutaneous coronary intervention (PCI) during transcatheter aortic valve implantation (TAVI) setting is still highly debated. This study aimed to assess the safety and the effectiveness of TAVI and PCI performed in the same session compared with TAVI alone. METHODS: Patients with severe aortic stenosis and coronary artery disease (CAD) (N.=786) who underwent TAVI from June 2007 to April 2021 were divided into two groups: patients who underwent TAVI alone (N.=633) and patients treated with TAVI and concomitant PCI (N.=153). The propensity-score matching adjustment was used to account for baseline confounding variables. RESULTS: A total of 302 TAVI with CAD patients (151 matched pairs), undergoing either isolated TAVI or TAVI+PCI were compared. In-hospital death (6% vs. 4%; P=0.427), stroke (2% vs. 0.7%; P=0.314), myocardial infarction (MI) (0% vs. 0.7%; P=0.317), major and life-threatening bleeding (14.6% vs. 15.9%; P=0.749), and acute kidney injury (9.3% vs. 10.6%; P=0.700) were similar for both groups. At 3 years, the rates of all-cause death (25.2% vs. 19.2%; P=0.615), the composite endpoints of all-cause death and MI (27.2% vs. 21.2%; P=0.699) and all-cause death, MI, and stroke (28.5% vs. 22.5%; P=0.739) were also comparable between the two groups. Achieving complete coronary revascularization in the TAVI setting did not impact on long-term mortality (P=0.257). CONCLUSIONS: In patients with severe aortic stenosis and CAD, concomitant TAVI and PCI was as safe and effective as TAVI alone up to 3-year follow-up.

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Cite This Study

Valvo et al. (2022) conducted a cohort in severe aortic stenosis and coronary artery disease (n=786). TAVI and concomitant PCI vs. TAVI alone was evaluated on all-cause death at 3 years (p=0.615). Concomitant TAVI and PCI was associated with similar 3-year rates of all-cause death compared to TAVI alone in patients with severe aortic stenosis and CAD (19.2% vs 25.2%; P=0.615).

synapsesocial.com/papers/6aaa0c6b1a5deadb6735e8d2 https://doi.org/10.23736/s2724-5683.22.06025-2