Comparison of Outcomes of Transcatheter Aortic Valve Replacement Plus Percutaneous Coronary Intervention Versus Transcatheter Aortic Valve Replacement Alone in the United States.
Transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) has emerged as a less-invasive therapeutic option for high surgical risk patients with aortic stenosis and coronary artery disease. The aim of this study was to determine the outcomes of TAVR when performed with PCI during the same hospitalization. We identified patients using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes from the Nationwide Inpatient Sample between the years 2011 and 2013. A total of 22,344 TAVRs were performed between 2011 and 2013. Of these, 21,736 (97.3%) were performed without PCI (TAVR group) while 608 (2.7%) along with PCI (TAVR + PCI group). Among the TAVR + PCI group, 69.7% of the patients had single-vessel, 22.2% had 2-vessel, and 1.6% had 3-vessel PCI. Drug-eluting stents were more commonly used than bare-metal stents (72% vs 28%). TAVR + PCI group witnessed significantly higher rates of mortality (10.7% vs 4.6%) and complications: vascular injury requiring surgery (8.2% vs 4.2%), cardiac (25.4% vs 18.6%), respiratory (24.6% vs 16.1%), and infectious (10.7% vs 3.3%), p <0.001% for all, compared with the TAVR group. The mean length of hospital stay and cost of hospitalization were also significantly higher in the TAVR + PCI group. The propensity score-matched analysis yielded similar results. In conclusion, performing PCI along with TAVR during the same hospital admission is associated with higher mortality, complications, and cost compared with TAVR alone. Patients would perhaps be better served by staged PCI before TAVR.
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: vikas.dr.singh@gmail.com.
Vikas
V
Singh
Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
Alex P
AP
Rodriguez
Cardiovascular Division, Cleveland Clinic, Ohio.
Badal
B
Thakkar
Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
Nileshkumar J
NJ
Patel
Cardiology Department, Southwest Heart, Las Cruces, New Mexico.
Abhijit
A
Ghatak
Cardiovascular Division, The Everett Clinic, Everett, Washington.
Apurva O
AO
Badheka
Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
Carlos E
CE
Alfonso
Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
Eduardo
E
de Marchena
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Rahul
R
Sakhuja
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Ignacio
I
Inglessis-Azuaje
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Igor
I
Palacios
Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
Mauricio G
MG
Cohen
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Sammy
S
Elmariah
Division of Cardiology, Henry Ford Hospital, Detroit, Michigan.
William W
WW
O'Neill
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D014481:United States / Q000453:epidemiology