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Unplanned Percutaneous Coronary Revascularization After TAVR: A Multicenter International Registry
Giulio G Stefanini1, Enrico Cerrato2, Carlo Andrea Pivato1
1Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy.
Insights
Unplanned percutaneous coronary intervention (PCI) after transcatheter aortic valve replacement (TAVR) is rare and decreases over time. Acute coronary syndromes are the primary reason for PCI within two years, followed by chronic coronary syndromes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) and aortic stenosis often coexist.
- Optimal management of CAD post-transcatheter aortic valve replacement (TAVR) requires further elucidation.
Purpose of the Study:
- To evaluate the incidence and causes of percutaneous coronary intervention (PCI) at various time points after TAVR.
- To analyze the indications for PCI in patients who have undergone TAVR.
Main Methods:
- Retrospective analysis of patients undergoing unplanned PCI after TAVR within an international multicenter registry.
- Inclusion criteria: Patients who underwent unplanned PCI post-TAVR between July 2008 and March 2019.
Main Results:
- 133 patients (0.9%) underwent unplanned PCI after TAVR.
- Median time to PCI was 191 days; incidence was highest in the first week post-TAVR and declined thereafter.
- Acute coronary syndromes were the main indication for PCI within the first two years, with chronic coronary syndromes becoming prevalent beyond two years.
- PCI success rate was high (96.6%), with no significant difference between balloon-expandable and self-expandable bioprostheses.
Conclusions:
- Unplanned PCI post-TAVR is uncommon and its incidence decreases over time.
- Acute coronary syndromes are the primary indication for PCI in the initial two years, shifting to chronic coronary syndromes later.
- Successful PCI can be performed after TAVR, irrespective of bioprosthesis type.
Objectives:
This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR).
Background:
Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated.
Methods:
Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry.
Results:
Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non-ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150).
Conclusions:
Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501).
