Coronary artery disease negatively affects the outcome of patients undergoing surgical
aortic valve replacement and practice guidelines recommend revascularization at time
of surgery. In patients undergoing transcatheter aortic valve implantation (TAVI),
the impact of preprocedural percutaneous coronary intervention (PCI) on TAVI outcome
has not been examined. We aimed in the present study to assess the feasibility and
safety of performing PCI before TAVI and to evaluate procedural, 30-day, and 6-month
clinical outcomes. We retrospectively analyzed 125 patients who underwent successful
TAVI at a single institution and divided them into an isolated TAVI and a PCI + TAVI
group. During the study period, a strategy of preprocedural PCI of all significant
(>50%) lesions in major epicardial vessels was adopted. Study end points were adjudicated
in accordance with the Valve Academic Research Consortium consensus on event definition.
All patients were treated with the Medtronic CoreValve prosthesis (n = 55 with PCI
+ TAVI and n = 70 with isolated TAVI). Thirty-day mortality was 2% versus 6% for patients
treated with PCI + TAVI versus isolated TAVI, respectively (p = 0.27). Neither periprocedural
nor spontaneous myocardial infarction occurred in either group. Rates of 30-day stroke,
major bleeding, major vascular complications, and the Valve Academic Research Consortium–defined
combined safety end point (11% vs 13%, p = 0.74) did not differ between the 2 groups.
Patients' symptoms significantly improved in the first month after TAVI, and extent
of improvement did not differ between groups. Adverse events at 6 months were comparable.
In conclusion, PCI before TAVI appears feasible and safe. Based on these early results
revascularization should become an important consideration in patients with coronary
artery disease undergoing TAVI.
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Article info
Publication history
Published online: December 02, 2011
Accepted:
September 29,
2011
Received in revised form:
September 29,
2011
Received:
July 31,
2011
Footnotes
Dr. Mostafa is currently at Ain Shams University Hospital, Cairo, Egypt.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
