title: Impact of coronary artery disease and percutaneous coronary intervention on outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Coronary artery disease (CAD) is frequently present in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). While revascularisation affects peri-operative outcome in patients undergoing surgical aortic valve replacement, the impact of percutaneous coronary intervention (PCI) in patients undergoing TAVI is not well established.
  
  
  RESULTS
  Consecutive patients with severe AS undergoing TAVI were prospectively included into the Bern TAVI registry. In patients with CAD, myocardium at risk was assessed using the DUKE myocardial jeopardy score. Revascularisation was performed by means of PCI either staged or concomitant at the time of TAVI. Among 256 patients undergoing TAVI, 167 patients had CAD and 59 patients underwent either staged (n=23) or concomitant (n=36) PCI. Clinical outcome at 30 days was similar for patients undergoing isolated TAVI as compared with TAVI combined with PCI in terms of death (5.6% versus 10.2%, p=0.24), major stroke (4.1% versus 3.4%, p=1.00), and the VARC combined safety endpoint (31.0% versus 23.7%, p=0.33). A stratified analysis of outcomes according to presence of CAD or revascularisation showed no difference during long-term follow-up (log rank p=0.16).
  
  
  CONCLUSIONS
  CAD is frequent among patients with severe AS undergoing TAVI. Among carefully selected patients, revascularisation by means of PCI can be safely performed in addition to TAVI either as a staged or a concomitant intervention.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Enio
authors.initials: E
authors.lastname: Guerios
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Alexander
authors.initials: A
authors.lastname: Kadner
authors.forename: Lutz
authors.initials: L
authors.lastname: Buellesfeld
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D011446:Prospective Studies; D012042:Registries; D051437:Renal Insufficiency / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography