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Published on: August 8, 2025
Staged versus concomitant transcatheter aortic valve replacement and percutaneous coronary intervention: A national
Zachary Tran1, Joseph Hadaya1, Peter Downey2
1Division of Cardiac Surgery, Department of Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, Calif.
Insights
Performing percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) together (Concomitant) showed similar mortality but fewer acute kidney injury cases and lower costs compared to staged procedures. Concomitant PCI/TAVR may be suitable for select patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Traditionally, severe coronary artery disease and aortic stenosis were treated with open-heart surgery.
- Percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) are emerging alternatives.
- Optimal timing for combined PCI and TAVR remains unclear.
Purpose of the Study:
- To evaluate the outcomes of staged versus concomitant PCI/TAVR procedures.
- To compare in-hospital mortality, perioperative complications, and hospitalization costs.
- To identify associations between PCI/TAVR timing and patient outcomes.
Main Methods:
- Analysis of the 2016-2018 Nationwide Readmissions Database for adult patients undergoing both TAVR and PCI.
- Classification of procedures into Concomitant (same day) and Staged (early or late).
- Multivariable regression models to assess the impact of TAVR timing on outcomes, including mortality and acute kidney injury.
Main Results:
- Concomitant PCI/TAVR was performed in 14.4% of patients, Early-Staged in 12.7%, and Late-Staged in 72.8%.
- Staged procedures were associated with significantly higher odds of acute kidney injury compared to Concomitant.
- Staged PCI/TAVR resulted in longer hospital stays and increased costs.
Conclusions:
- Concomitant PCI/TAVR is linked to similar in-hospital mortality but reduced acute kidney injury and lower resource utilization.
- Staged PCI/TAVR procedures are associated with increased risks of acute kidney injury and higher healthcare costs.
- Concomitant PCI/TAVR may be a reasonable approach for carefully selected patients.
Objective:
Although patients with significant coronary artery disease and aortic stenosis have traditionally undergone open valve replacement and bypass grafting, percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) are increasingly considered. Because of the lack of data regarding timing of PCI/TAVR, in the present study we evaluated associations of staged and concomitant PCI/TAVR on outcomes in a nationally representative cohort.
Methods:
Adults who underwent TAVR and PCI were identified using the 2016 to 2018 Nationwide Readmissions Database. If PCI/TAVR occurred on the same day, patients were considered Concomitant and otherwise considered Staged. Staged were further classified as Early-Staged if both occurred in the same hospitalization or Late-Staged if TAVR ensued PCI in a subsequent hospitalization. Multivariable regression models were developed to evaluate the association of TAVR timing on outcomes. The primary end point was in-hospital mortality whereas perioperative complications including acute kidney injury and hospitalization costs were secondarily considered.
Results:
Of an estimated 5843 patients, 843 (14.4%) were Concomitant and 745 (12.7%) and 4255 (72.8%) were Early-Staged and Late-Staged, respectively. Although age and TAVR access were similar, Concomitant had a lower proportion of chronic kidney disease and more commonly underwent single-vessel PCI. Staged showed similar risk-adjusted mortality but greater odds of acute kidney injury (Early-Staged adjusted odds ratio: 2.68; 95% CI, 1.57-4.55 and Late-Staged: 1.97; 95% CI, 1.29-2.99) compared with Concomitant. Although post-TAVR hospitalization duration was similar, total length of stay and costs were increased in Staged.
Conclusions:
Concomitant PCI/TAVR was associated with similar rates of in-hospital mortality but reduced rates of acute kidney injury and lower resource utilization. While evaluating patient-specific factors, concomitant PCI/TAVR might be reasonable in select individuals.
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