The Benefit of Percutaneous Coronary Intervention Before Transcatheter Aortic Valve Replacement: A Multicenter Retrospective Outcome-Based Study

Wassim Mosleh; Jeffery F Mather; Augustin J Delago Jr; Lauren Eastman; Nathan Crain; Emily L Swann; Rohit Masih; James T DeVries; Raymond G McKay; Michael N Young

doi:10.1016/j.amjcard.2023.08.064

The Benefit of Percutaneous Coronary Intervention Before Transcatheter Aortic Valve Replacement: A Multicenter Retrospective Outcome-Based Study

Am J Cardiol. 2023 Nov 1:206:175-184. doi: 10.1016/j.amjcard.2023.08.064. Epub 2023 Sep 12.

Affiliations

¹ Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
² Departments of Research Administration.
³ Cardiology, Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut.
⁴ Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: michael.n.young@hitchcock.org.

PMID: 37708748
DOI: 10.1016/j.amjcard.2023.08.064

Abstract

There is inadequate evidence regarding the role of percutaneous coronary intervention (PCI) in patients who underwent transcatheter aortic valve replacement (TAVR). The current American Heart Association/American College of Cardiology guidelines are limited to class 2A recommendations for pre-TAVR revascularization in the setting of hemodynamically significant left main (LM), proximal left anterior descending (pLAD), or extensive bifurcation disease regardless of angina status. We performed a multicenter, retrospective, observational study assessing the benefit of PCI in patients with coronary artery disease who underwent transfemoral TAVR for severe symptomatic aortic stenosis. Patients were divided into 2 cohorts: (1) patients who did not undergo pre-TAVR PCI within the preceding 12 months (no-PCI group) and (2) patients who received pre-TAVR PCI within the preceding 12 months (PCI group). The primary outcome was defined as the composite end point of in-hospital and 30-day adverse events, including all-cause mortality, cardiac arrest, and myocardial infarction. Subgroup analyses were performed on patients with LM and/or pLAD disease and other high-risk features, including angina and heart failure. Comparisons were made between 1,809 consecutive patients (1,364 in the no-PCI group and 445 in the PCI group). There were no differences between the 2 cohorts regarding the primary composite outcome (2.0% vs 2.8%, p = 0.918) or individual secondary outcomes. Although LM/pLAD disease, New York Heart Association classes III to IV, and Society of Thoracic Surgeons risk score ≥8 were all independent predictors of the primary outcome, none of the subgroups demonstrated a benefit favoring PCI. In conclusion, there is no observed benefit from PCI within 12 months pre-TAVR in patients with severe aortic stenosis and concomitant coronary artery disease, including patients with LM/pLAD disease.

Keywords: aortic stenosis; percutaneous coronary intervention; transcatheter aortic valve replacement.