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Percutaneous coronary intervention in patients with severe aortic stenosis: implications for transcatheter aortic

Sachin S Goel1, Shikhar Agarwal, E Murat Tuzcu

  • 1Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, J2-3, 9500 Euclid Ave, Cleveland, OH 44195, USA. kapadis@ccf.org

Circulation
|January 28, 2012
PubMed

Insights

Percutaneous coronary intervention (PCI) in patients with severe aortic stenosis (AS) shows similar short-term mortality to those without AS. However, patients with low ejection fraction or high surgical risk scores face increased 30-day mortality after PCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Management of coronary artery disease (CAD) in severe aortic stenosis (AS) is complex, especially with transcatheter aortic valve replacement (TAVR) availability.
  • Outcomes of percutaneous coronary intervention (PCI) in patients with severe AS and CAD are not well-established.
  • This study compares short-term PCI outcomes in patients with and without severe AS.

Purpose of the Study:

  • To compare the short-term outcomes of PCI in patients with and without severe aortic stenosis.
  • To identify risk factors for mortality following PCI in patients with severe AS.

Main Methods:

  • Retrospective analysis of a PCI database from 1998-2008.
  • Inclusion of 254 patients with severe AS and 508 propensity-matched patients without AS who underwent PCI.
  • Primary endpoint: 30-day mortality post-PCI.

Main Results:

  • 30-day mortality after PCI was similar between patients with and without severe AS (4.3% vs. 4.7%, P=0.2).
  • Patients with severe AS and low ejection fraction (≤30%) had significantly higher 30-day mortality (5.4% vs. 1.2%, P<0.001).
  • Patients with severe AS and high Society of Thoracic Surgeons (STS) score (≥10) also had higher 30-day mortality (10.4% vs. 0%, P<0.001).

Conclusions:

  • PCI can be safely performed in patients with severe symptomatic AS and CAD, with no increased short-term mortality compared to controls.
  • Low ejection fraction and high STS score are critical predictors of 30-day mortality post-PCI in severe AS patients.
  • Findings guide management decisions for high-risk severe AS patients undergoing PCI, particularly those considered for TAVR.
Abstract

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