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Short- and Mid-Term Outcomes of Complex and High-Risk Versus Standard Percutaneous Coronary Interventions in Patients
Arber Kodra, Craig Basman, Luigi Pirelli
1Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, 130 East 77th Street, 4th floor, New York, NY 10075 USA. ckliger@northwell.edu.
Insights
Complex and high-risk percutaneous coronary interventions (CHIP-PCIs) combined with TAVR showed comparable safety to standard PCI and TAVR, despite higher initial adverse event rates. This suggests CHIP-PCI is a safe option for patients with complex coronary artery disease and severe aortic stenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) prevalence in TAVR patients is variable, linked to worse outcomes.
- Complex and high-risk percutaneous coronary interventions (CHIP-PCIs) in severe aortic stenosis (AS) patients undergoing TAVR require evaluation.
Purpose of the Study:
- To compare outcomes of CHIP-PCI combined with TAVR versus standard PCI combined with TAVR.
- To assess the safety and efficacy of CHIP-PCI in patients with severe AS.
Main Methods:
- Retrospective review of 276 patients undergoing TAVR and PCI between January 2014 and March 2021.
- CHIP-PCI defined by specific criteria including low ejection fraction, left main disease, CTO, LV support, or atherectomy.
- Comparison of major adverse cardiac or cerebrovascular events (MACCE) at 30 days and 1 year between CHIP-PCI/TAVR and standard PCI/TAVR groups.
Main Results:
- CHIP-PCI/TAVR had a higher 30-day MACCE rate (4.9% vs 1.3%), primarily due to stroke.
- One-year MACCE rates were higher in CHIP-PCI/TAVR (8.7% vs 4%), driven by revascularization, but not statistically significant.
- No significant differences in vascular complications or New York Heart Association functional classification were observed between groups.
Conclusions:
- CHIP-PCI can be safely performed in patients with complex CAD undergoing TAVR.
- The study supports the safety of CHIP-PCI in this complex patient population, despite initial trends in adverse events.
Background:
The prevalence of coronary artery disease (CAD) in patients undergoing TAVR varies and is associated with increased morbidity and mortality. We evaluated the outcomes of complex and high-risk percutaneous coronary interventions (CHIP-PCIs) and TAVR compared with standard PCI and TAVR. Between January 2014 and March 2021, a total of 276 consecutive patients with severe aortic stenosis (AS) who underwent TAVR and PCI at 3 centers within Northwell Health were retrospectively reviewed. CHIP-PCI was defined as PCI with one of the following: left ventricular ejection fraction (LVEF) <30%; left main coronary artery (LMCA)/chronic total occlusion (CTO) intervention; atherectomy; or need for left ventricular (LV) support. One hundred twenty- seven patients (46%) had CHIP-PCI prior to TAVR and 149 patients (54%) had standard PCI. Thirteen percent of CHIP-PCI and 22% of standard PCI cases were done concomitantly with TAVR. CHIP-PCI criteria were met for low EF (19%), LMCA (25%), CTO (3%), LV support (20%), and atherectomy (50%). The types of valves used were similarly divided (49% balloon expandable vs 51% self expanding. Major adverse cardiac or cerebrovascular event (MACCE) rate for CHIP-PCI/TAVR was 4.9% at 30 days vs 1.3% for standard PCI/TAVR (P=.09), driven by in-hospital stroke. At 1 year, the rates of MACCE for CHIP-PCI/TAVR remained higher than for standard PCI/TAVR, but was not statistically significant (8.7% vs 4%; P=.06), driven by revascularization. We found no differences between major and/or minor vascular complications. New York Heart Association classification at 1 month was similar (I/II 93% vs 95%; P=.87). Our study suggests that CHIP-PCI can be safely performed in patients with complex CAD and concomitant severe AS.
