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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Clinical impact of complex percutaneous coronary intervention in the pre-TAVR workup

Marisa Avvedimento1, Francisco Campelo-Parada2, Luis Nombela-Franco3

  • 1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.

Revista Espanola De Cardiologia (English Ed.)
|May 19, 2024
PubMed

Insights

Complex percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) increases the risk of major adverse cardiac events (MACE). PCI complexity is a key predictor of prognosis in TAVR patients with coronary artery disease.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
  • Patients undergoing TAVR often have significant coronary artery disease requiring percutaneous coronary intervention (PCI).
  • The impact of PCI complexity on outcomes after TAVR is not well understood.

Purpose of the Study:

  • To investigate the association between PCI complexity and clinical outcomes in patients undergoing TAVR.
  • To identify PCI complexity as a predictor of major adverse cardiac events (MACE) post-TAVR.

Main Methods:

  • Multicenter study of 1550 patients scheduled for TAVR with coronary artery disease.
  • Complex PCI defined by criteria including number of vessels treated, stents, lesions, bifurcation stenting, stent length, or chronic total occlusion.
  • Evaluation of MACE, including cardiovascular death, myocardial infarction, and repeat revascularization.

Main Results:

  • Nearly 30% of patients (454/1550) underwent complex PCI.
  • Complex PCI was associated with a significantly increased risk of cardiac death, myocardial infarction, and coronary revascularization.
  • PCI complexity independently predicted MACE after TAVR (HR 1.31).

Conclusions:

  • Complex PCI in TAVR candidates with coronary artery disease is linked to higher MACE rates.
  • Procedural complexity of PCI should be considered when assessing prognosis in the TAVR population.
Abstract

Keywords:
Complex PCIICPICP complejaImplante percutáneo de válvula aórticaIntervención coronaria percutáneaPCIPercutaneous coronary interventionTAVITAVRTranscatheter aortic valve replacement

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