Abstract 16516: Timing of Staged Percutaneous Coronary Intervention Prior to Transcatheter Aortic Valve Implantation: Outcome Implications
Background: Significant coronary artery disease (CAD) is highly prevalent among patients with severe aortic stenosis referred for transcatheter aortic valve implantation (TAVI). Timing of staged percutaneous coronary intervention (PCI) in TAVI candidates remains debated.
Objective: To assess the impact of staged PCI short- and long-term before TAVI on the outcomes of TAVI.
Methods: A total of 96 patients (mean age 81±5 years, 57.3% men) who had undergone staged PCI within 1 year before TAVI were included. The decision to perform staged PCI was based on the extent of myocardial tissue at risk and technical complexity while PCI timing was based on patient’s clinical status and logistical issues. The population was dichotomized according to the median number of days elapsed between PCI and TAVI. All in-hospital events and 30-day outcomes after TAVI were defined according to the Valve Academic Research Consortium-2.
Results: The median number of days elapsed between PCI and TAVI was 29 [9-81]. Forty-eight patients underwent PCI >29 days before TAVI while the remaining 48 patients underwent PCI ≤29 days. Except lower haemoglobin levels at TAVI admission (7.2±0.9 mmol/L vs. 7.9±0.9 mmol/L, p=0.002) and a higher frequency of atrial fibrillation (27.1% vs. 12.5%, p=0.018), the group of patients treated with PCI ≤29 days was comparable with the group >29 days. Minor vascular injury and minor bleedings were more frequently recorded among those treated with staged PCI ≤29days before TAVI (Table) as compared with their counterparts. There were no differences in the incidence of other events (Table). Kaplan-Meier curves demonstrated a 2-year survival of 74.8% and 76.8% (p=0.36) for patients treated with staged PCI ≤29days and >29days.
Conclusions: Early (≤29 days) or remote (>29 days) staged PCI before TAVI results in comparable outcomes with the exception of minor vascular injury and minor bleeding events which were more frequently observed in patients treated with early staged PCI.
Author Disclosures: P. van Rosendael: None. F. van der Kley: None. V. Kamperidis: Research Grant; Significant; European Association of Cardiovascular Imaging research grant, Hellenic Foundation of Cardiology research grant. S. Katsanos: Research Grant; Significant; Hellenic Foundation of Cardiology research grant. I. Al Amri: None. M. Regeer: None. M. Schalij: None. N. Ajmone Marsan: None. J. Bax: None. V. Delgado: Speakers Bureau; Modest; Abbott Vascular.
- © 2014 by American Heart Association, Inc.