Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation.

Rheude, Tobias; Costa, Giuliano; Ribichini, Flavio Luciano; Pilgrim, Thomas; Amat Santos, Ignacio J; De Backer, Ole; Kim, Won-Keun; Ribeiro, Henrique Barbosa; Saia, Francesco; Bunc, Matjaz; Tchetche, Didier; Garot, Philippe; Mylotte, Darren; Burzotta, Francesco; Watanabe, Yusuke; Bedogni, Francesco; Tesorio, Tullio; Tocci, Marco; Franzone, Anna; Valvo, Roberto; ... (2023). Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation. EuroIntervention, 19(7), pp. 589-599. Europa Digital & Publishing 10.4244/EIJ-D-23-00186

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BACKGROUND

The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown.

AIMS

We sought to compare different PCI timing strategies in TAVI patients.

METHODS

The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method.

RESULTS

A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days.

CONCLUSIONS

In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1774-024X

Publisher:

Europa Digital & Publishing

Language:

English

Submitter:

Pubmed Import

Date Deposited:

13 Jul 2023 11:23

Last Modified:

19 Sep 2023 00:14

Publisher DOI:

10.4244/EIJ-D-23-00186

PubMed ID:

37436190

URI:

https://boris.unibe.ch/id/eprint/184727

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