Percutaneous Coronary Intervention in Patients with Severe Aortic Stenosis: Implications for Transcatheter Aortic Valve Replacement
Background—With the availability of Transcatheter Aortic Valve Replacement (TAVR), management of coronary artery disease (CAD) in patients with severe Aortic Stenosis (AS) is posing challenges. Outcomes of percutaneous coronary intervention (PCI) in patients with severe AS and CAD remain unknown. We sought to compare the short term outcomes of PCI in patients with and without AS.
Methods and 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% (11/254) vs. 4.7% (24/508) (HR 0.93, 95% CI 0.51-1.69, p=0.2)]. Patients with low EF (≤30%) and severe AS had a higher 30-day post-PCI mortality compared to those with EF >30% [5.4% (7/45) vs. 1.2% (4/209), p<0.001]. In addition, AS patients with high STS score (≥10) had a higher 30-day post-PCI mortality compared to in those with STS score <10 [10.4% (10/96) vs. 0%, p<0.001].
Conclusions—PCI can be performed in patients with severe symptomatic AS and CAD without an increased risk of short term mortality compared to propensity matched patients without AS. Patients with EF ≤30% and STS score ≥10% are at a highest risk of 30-day mortality after PCI. This finding has significant implications in the management of severe CAD in high risk severe symptomatic AS patients being considered for TAVR.
- coronary artery disease
- percutaneous coronary intervention
- severe aortic stenosis
- surgical aortic valve replacement
- transcatheter aortic valve replacement
- Received April 23, 2011.
- Accepted December 20, 2011.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited