Adverse clinical outcomes in patients undergoing both PCI and TAVR: Analysis from a pooled multi-center registry

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Limited data exists on the optimal timing for percutaneous coronary intervention (PCI) in relation to transcatheter aortic valve replacement (TAVR).
• Understanding the impact of PCI timing on outcomes is crucial for managing patients with concomitant coronary artery disease and severe aortic stenosis.

Purpose of the Study:

• To compare the rates of major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing PCI before TAVR versus those receiving PCI concurrently with or after TAVR.
• To identify factors associated with adverse events in patients who underwent both PCI and TAVR.

Main Methods:

• A multicenter study pooling data from three high-volume centers involving patients who underwent TAVR.
• Retrospective analysis of 3,982 TAVR patients, with a focus on the 380 who also underwent PCI.
• Comparison of MACCE rates between patients who had PCI before TAVR and those who had PCI with or after TAVR.

Main Results:

• No significant differences in MACCE, all-cause mortality, strokes, or repeat PCI were observed between patients who underwent PCI before TAVR and those who underwent PCI with or after TAVR.
• Factors associated with lower MACCE in the combined PCI and TAVR group included prior coronary artery bypass grafting (CABG), higher BMI, and statin therapy post-TAVR.
• Warfarin therapy post-TAVR was associated with a higher risk of MACCE.

Conclusions:

• The timing of PCI in relation to TAVR does not appear to significantly affect adverse event rates.
• History of CABG, higher BMI, and statin use are associated with better outcomes, while warfarin use is linked to increased adverse events in patients undergoing both procedures.
• These findings suggest a flexible approach to PCI timing in TAVR patients may be appropriate.