title: Concomitant coronary intervention is associated with poorer early and late clinical outcomes in selected elderly patients receiving transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Significant coronary artery disease (CAD) is common among patients currently evaluated for transcatheter aortic valve implantation (TAVI). Limited data exist on the outcome of patients undergoing combined transcatheter treatment of aortic valve disease and CAD. The aim of the study was to analyse the impact of concomitant percutaneous coronary intervention (PCI) on early and late clinical outcomes of patients receiving TAVI.
  
  
  METHODS
  TAVIs were performed through either transfemoral or transapical access using SAPIEN (XT), CoreValve or AcurateTA valves. PCI was decided by the interdisciplinary heart team and performed synchronously or as a staged procedure upfront. Standardized valve academic research consortium (VARC)-2 endpoints were used. In case of a staged approach, TAVI was defined as the index procedure. Thirty-day outcomes and Kaplan-Meier 2-year survival were analysed.
  
  
  RESULTS
  Of 411 TAVIs, 65 (16%) received PCI. Mean age was 82 years (P = 0.92) and mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 21.7% (TAVI + PCI) and 20.3% (TAVI; P = 0.47). PCI was performed as staged procedure upfront (74%) or synchronously (26%). In 95% of PCIs, a single coronary artery was treated, and 71% received bare metal stents. Incidence of myocardial infarction (6 vs 1%; P = 0.01) and 30-day mortality (15 vs 5%; P = 0.01) were higher in the TAVI + PCI group, compared with the TAVI group. Synchronous (18%) vs staged (15%) approach for PCI had comparable early mortality (P = 1.0). Kaplan-Meier 2-year survival was poorer in the TAVI + PCI group (P = 0.03) with an odds ratio of 1.66 (P = 0.04).
  
  
  CONCLUSIONS
  Concomitant PCI is--when based on current heart team practice--associated with increased early and late mortality in selected elderly patients undergoing TAVI.
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt (Saale), Germany dgriese@gmx.de.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Griese
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt (Saale), Germany.
authors.forename: Wilko
authors.initials: W
authors.lastname: Reents
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt (Saale), Germany.
authors.forename: Attila
authors.initials: A
authors.lastname: Tóth
authors.affiliation: Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt (Saale), Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kerber
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt (Saale), Germany.
authors.forename: Anno
authors.initials: A
authors.lastname: Diegeler
authors.affiliation: Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt (Saale), Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Babin-Ebell
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery; D001705:Bioprosthesis / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology*; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011475:Prosthesis Failure; D015607:Stents
keywords: Aortic valve stenosis; Coronary artery disease; PCI; Transcatheter aortic valve implantation