Abstract 14951: Aortic Stenosis In High-risk Patients Presenting Coronary Artery Disease: Conventional Or Transcatheter Strategy? A Propensity Score Analysis
Objectives: Aortic valve replacement with CABG surgery is currently the standard therapy for patients with aortic stenosis (AS) and concomitant coronary artery disease (CAD). We sought to determine whether transcatheter aortic valve implantation (TAVI) combined with percutaneous coronary intervention (PCI) might be an equivalent strategy.
Methods: A total of 243 high-risk patients (STS-Score >10% and/or EuroSCORE >15%) presenting AS with concomitant CAD were studied, treated either by surgical AVR combined with CABG (group 1, n=184) or by PCI within 12 months prior to transapical or transfemoral TAVI (group 2, n=59). A propensity score adjusted regression analysis was used to compare 30-day mortality as the primary study endpoint between the groups.
Results: Mean age (75±6years), EuroSCORE (18.1±13.8%) and STS-Score (13.1±8.7%) in group 1 was significantly different compared to group 2 (80±6years, 27.5±16.3% and 16.7±10.5%, P<0.001). Thirty-day mortality was 12.5% in group 1 compared to 11.9% in group 2 (OR 0.94, 95% CI 0.38-2.32, P=0.89). Univariate analysis revealed left ventricular ejection fraction (LVEF), pulmonary hypertension, renal insufficiency, STS-Score, EuroSCORE and previous cardiac surgery as predictors for 30-day mortality (P<0.05). Risk-adjusted multivariate regression analysis showed only LVEF to be strongly associated with 30-day mortality and confirmed no significant difference between the groups (P=0.44). To further control for study bias, a 10-layer propensity score model based on the univariate analysis again confirmed equivalence regarding the primary endpoint (P=0.33).
Conclusion: The present study demonstrates that TAVI in combination with prior PCI within 12 months produces at least equivalent results in a propensity score matched high-risk patient population.
- Aortic stenosis
- Coronary heart disease
- Percutaneous coronary intervention
- Transcatheter Aortic Valve Implantation
- © 2011 by American Heart Association, Inc.