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Insight Into the Optimal Timing of Percutaneous Coronary Intervention and Transcatheter Aortic Valve Replacement

Dae Yong Park1, Matheus Simonato2, Yousif Ahmad3

  • 1Department of Medicine, Cook County Health, Chicago, IL.

Current Problems in Cardiology
|August 29, 2023
PubMed

Insights

Performing percutaneous coronary intervention (PCI) on the same day as transcatheter aortic valve replacement (TAVR) is linked to better outcomes. Concomitant PCI and TAVR reduces 90-day readmissions and acute kidney injury compared to TAVR shortly after PCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Healthcare Outcomes Research

Background:

  • Many patients undergoing transcatheter aortic valve replacement (TAVR) have coexisting coronary artery disease requiring revascularization.
  • Optimal timing for percutaneous coronary intervention (PCI) in relation to TAVR is not well-established, impacting clinical decisions.

Purpose of the Study:

  • To evaluate the impact of PCI timing on clinical outcomes and readmissions following TAVR.
  • To compare outcomes across different intervals between PCI and TAVR procedures.

Main Methods:

  • Retrospective analysis of the National Readmissions Database (2016-2019).
  • Patients were stratified into three groups based on PCI-TAVR timing: same-day, TAVR ≤30 days post-PCI, and TAVR >30 days post-PCI.
  • Comparison of in-hospital mortality, acute kidney injury, nonhome discharge, and 90-day readmissions.

Main Results:

  • No significant difference in in-hospital mortality was observed across the PCI-TAVR timing groups.
  • TAVR performed ≤30 days after PCI was associated with increased odds of acute kidney injury (aOR 1.49), nonhome discharge (aOR 1.53), and 90-day readmission (aOR 1.35) compared to same-day procedures.
  • Concomitant PCI and TAVR demonstrated lower rates of 90-day readmissions and acute kidney injury.

Conclusions:

  • Same-day PCI and TAVR is associated with favorable outcomes, including reduced acute kidney injury and 90-day readmissions.
  • Performing TAVR shortly after PCI (≤30 days) is linked to poorer outcomes.
  • Concomitant PCI and TAVR should be considered for select patients undergoing TAVR with coronary artery disease.

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