title: Percutaneous coronary intervention in patients with severe aortic stenosis: implications for transcatheter aortic valve replacement.
abstract: BACKGROUND
  With the availability of transcatheter aortic valve replacement, management of coronary artery disease in patients with severe aortic stenosis (AS) is posing challenges. Outcomes of percutaneous coronary intervention (PCI) in patients with severe AS and coronary artery disease remain unknown. We sought to compare the short-term outcomes of PCI in patients with and without AS.
  
  
  RESULTS
  From our PCI database, we identified 254 patients with severe AS who underwent PCI between 1998 and 2008. Using propensity matching, we found 508 patients without AS who underwent PCI in the same period. The primary end point of 30-day mortality after PCI was similar in patients with and without severe AS (4.3% [11 of 254] versus 4.7% [24 of 508]; hazard ratio, 0.93; 95% confidence interval, 0.51-1.69; P=0.2). Patients with low ejection fraction (≤30%) and severe AS had a higher 30-day post-PCI mortality compared with those with an ejection fraction >30% (5.4% [7 of 45] versus 1.2% [4 of 209]; P<0.001). In addition, AS patients with high Society of Thoracic Surgeons score (≥10) had a higher 30-day post-PCI mortality than those with a Society of Thoracic Surgeons score <10 (10.4% [10 of 96] versus 0%; P<0.001).
  
  
  CONCLUSIONS
  PCI can be performed in patients with severe symptomatic AS and coronary artery disease without an increased risk of short-term mortality compared with propensity-matched patients without AS. Patients with ejection fraction ≤30% and Society of Thoracic Surgeons score ≥10% are at a highest risk of 30-day mortality after PCI. This finding has significant implications in the management of severe coronary artery disease in high-risk severe symptomatic AS patients being considered for transcatheter aortic valve replacement.
authors.affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, J2-3, 9500 Euclid Ave, Cleveland, OH 44195, USA. kapadis@ccf.org
authors.forename: Sachin S
authors.initials: SS
authors.lastname: Goel
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Tarique
authors.initials: T
authors.lastname: Zaman
authors.forename: Navkaranbir
authors.initials: N
authors.lastname: Bajaj
authors.forename: Lee
authors.initials: L
authors.lastname: Joseph
authors.forename: Neil S
authors.initials: NS
authors.lastname: Patel
authors.forename: Olcay
authors.initials: O
authors.lastname: Aksoy
authors.forename: William J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000628:therapy*; D006328:Cardiac Catheterization / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D012955:Societies, Medical / Q000592:standards; D013903:Thoracic Surgery / Q000592:standards