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Published on: March 26, 2018
Percutaneous coronary intervention before transcatheter aortic valve implantation: A propensity score matched
Safi U Khan1, Sourbha S Dani2, Sarju Ganatra2
1Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States.
Insights
Percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) did not lower mortality. However, PCI was linked to a reduced need for repeat PCI within one year after TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- The management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) is complex.
- The optimal timing and necessity of percutaneous coronary intervention (PCI) before TAVR remain subjects of ongoing research and clinical debate.
Purpose of the Study:
- To investigate the association between PCI performed before TAVR and subsequent mortality and cardiovascular outcomes.
- To clarify the role of PCI in patients with stable CAD requiring TAVR.
Main Methods:
- A retrospective analysis of the TriNetX database from January 2012 to August 2022.
- Patients were categorized into two groups: those who underwent PCI within 3 months before TAVR and those who did not.
- Propensity score matching (PSM) was employed to compare outcomes at 30 days and 1 year.
Main Results:
- Out of 17,120 patients, 14% (2322) had prior PCI. In the PSM cohort (2026 patients per group), PCI before TAVR was not associated with reduced all-cause mortality at 30 days or 1 year.
- PCI was associated with a significantly lower rate of repeat PCI at 1 year (1.2% vs. 2.4%).
- No significant reductions were observed for myocardial infarction, heart failure exacerbation, all-cause hospitalization, major bleeding, or need for permanent pacemaker/ICD.
Conclusions:
- PCI performed prior to TAVR does not appear to improve all-cause mortality in patients with stable CAD.
- PCI before TAVR is associated with a decreased likelihood of requiring repeat PCI within one year post-procedure.
Background:
The role of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) who subsequently undergo transcatheter aortic valve replacement (TAVR) remains uncertain. Therefore, we conducted this study to assess the association of PCI before TAVR with mortality and cardiovascular outcomes.
Methods:
We used the TriNetX database (Jan 2012 - Aug 2022) and grouped patients into PCI (3 months or less) before TAVR and no PCI. We performed propensity score matched (PSM) analyses for outcomes at 30 days and 1 year.
Results:
Of 17,120 patients undergoing TAVR, 2322 (14 %) had PCI, and 14,798 (86 %) did not have PCI before TAVR. In the PSM cohort (2026 patients in each group), PCI was not associated with lower all-cause mortality at 30 days (HR: 1.25, 95 % CI: 0.82-1.90) or 1 year (HR: 1.02, 95 % CI: 0.83-1.24). Frequency of repeat PCI after TAVR was low in both no PCI vs. PCI (2.4 % vs. 1.2 %) at 1 year; PCI was associated with a lower rate of repeat PCI (HR: 0.49, 95 % CI: 0.30-0.80). Sensitivity analysis revealed an E-value of 3.5 for repeat PCI (E-value for lower CI for HR: 1.81). PCI was not linked to reductions in MI, heart failure exacerbation, all-cause hospitalization, major bleeding, or permanent pacemaker/implantable cardioverter defibrillator.
Conclusion:
This analysis showed that PCI prior to TAVR was not associated with improvement in all-cause mortality. However, PCI was associated with a reduced rate of repeat PCI at 1 year.
