title: Safety of percutaneous coronary intervention alone in symptomatic patients with moderate and severe valvular aortic stenosis and coexisting coronary artery disease: analysis of results in 56 patients.
abstract: Whether percutaneous coronary intervention (PCI) alone is safe in patients with moderate or severe aortic stenosis (AS) and coexisting coronary artery disease (CAD), and whether aortic valve replacement (AVR) can be deferred in patients with moderate AS by undergoing PCI alone is not known. We conducted a retrospective study of surgically inoperable patients with AS who underwent PCI (moderate AS, n = 28; and severe AS, n = 28) and compared to those with AVR (n = 55). The clinical characteristics, procedural complications, in-hospital and long-term clinical outcomes of PCI were compared. Baseline and procedural characteristics were similar except that lower age, hypertension, and renal impairment were seen in the AVR group. In-hospital complications were comparable among the 3 groups. Six-month and 1-year rates of myocardial infarction (MI), non-Q-wave MI, death and out-of-hospital death were similar between AVR and moderate AS patients (p = NS) and significantly high (p < 0.04) in patients with severe AS. On multivariate analysis, severe AS was the only significant predictor of 6-month and 1-year mortality. Our study suggests that PCI is safe in patients with moderate AS and coexisting CAD but is associated with poor outcomes in patients with severe AS.
authors.affiliation: Division of Cardiology, Washington Hospital Center, 110 Irving Street, N.W., Suite 4B-1, Washington, DC 20010, USA.
authors.forename: Pramod
authors.initials: P
authors.lastname: Kuchulakanti
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
authors.forename: Edouard
authors.initials: E
authors.lastname: Cheneau
authors.forename: Rajbabu
authors.initials: R
authors.lastname: Pakala
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Canos
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Pinnow
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001024:Aortic Valve Stenosis / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003324:Coronary Artery Disease / Q000150:complications*; D018572:Disease-Free Survival; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis