title: Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention.
abstract: Coronary artery disease negatively affects the outcome of patients undergoing surgical aortic valve replacement and practice guidelines recommend revascularization at time of surgery. In patients undergoing transcatheter aortic valve implantation (TAVI), the impact of preprocedural percutaneous coronary intervention (PCI) on TAVI outcome has not been examined. We aimed in the present study to assess the feasibility and safety of performing PCI before TAVI and to evaluate procedural, 30-day, and 6-month clinical outcomes. We retrospectively analyzed 125 patients who underwent successful TAVI at a single institution and divided them into an isolated TAVI and a PCI + TAVI group. During the study period, a strategy of preprocedural PCI of all significant (>50%) lesions in major epicardial vessels was adopted. Study end points were adjudicated in accordance with the Valve Academic Research Consortium consensus on event definition. All patients were treated with the Medtronic CoreValve prosthesis (n = 55 with PCI + TAVI and n = 70 with isolated TAVI). Thirty-day mortality was 2% versus 6% for patients treated with PCI + TAVI versus isolated TAVI, respectively (p = 0.27). Neither periprocedural nor spontaneous myocardial infarction occurred in either group. Rates of 30-day stroke, major bleeding, major vascular complications, and the Valve Academic Research Consortium-defined combined safety end point (11% vs 13%, p = 0.74) did not differ between the 2 groups. Patients' symptoms significantly improved in the first month after TAVI, and extent of improvement did not differ between groups. Adverse events at 6 months were comparable. In conclusion, PCI before TAVI appears feasible and safe. Based on these early results revascularization should become an important consideration in patients with coronary artery disease undergoing TAVI.
authors: Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel and Hamburg, Bad Segeberg, Germany. mohamed.abdel-wahab@segebergerkliniken.de
authors: Mohamed
authors: M
authors: Abdel-Wahab
authors: Ahmad E
authors: AE
authors: Mostafa
authors: Volker
authors: V
authors: Geist
authors: Björn
authors: B
authors: Stöcker
authors: Ken
authors: K
authors: Gordian
authors: Constanze
authors: C
authors: Merten
authors: Doreen
authors: D
authors: Richardt
authors: Ralph
authors: R
authors: Toelg
authors: Gert
authors: G
authors: Richardt
mesh_terms: D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D003324:Coronary Artery Disease / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011300:Preoperative Care; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology