PCI in Patients Undergoing Transcatheter Aortic-Valve Implantation

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• The role of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease undergoing transcatheter aortic-valve implantation (TAVI) is not well-defined.
• Severe aortic stenosis often coexists with coronary artery disease, necessitating complex treatment decisions.

Purpose of the Study:

• To evaluate the efficacy and safety of PCI in patients with severe symptomatic aortic stenosis and significant coronary artery disease undergoing TAVI.
• To compare a strategy of PCI plus TAVI versus TAVI with conservative treatment for coronary disease.

Main Methods:

• An international, randomized trial assigned 455 patients with severe aortic stenosis and coronary artery stenosis (FFR ≤0.80 or diameter stenosis ≥90%) to either PCI or conservative treatment, with all patients receiving TAVI.
• The primary endpoint was a composite of all-cause death, myocardial infarction, or urgent revascularization.
• Safety outcomes, including bleeding events and procedural complications, were assessed.

Main Results:

• At a median follow-up of 2 years, major adverse cardiac events occurred in 26% of the PCI group versus 36% of the conservative treatment group (HR, 0.71; 95% CI, 0.51 to 0.99; P=0.04).
• Bleeding events were more frequent in the PCI group (28%) compared to the conservative group (20%) (HR, 1.51; 95% CI, 1.03 to 2.22).
• PCI-related complications occurred in 3% of patients in the PCI group.

Conclusions:

• In patients with coronary artery disease undergoing TAVI, PCI was associated with a significantly lower risk of major adverse cardiac events at 2-year follow-up compared to conservative management.
• While PCI demonstrated improved clinical outcomes, increased bleeding events warrant consideration in patient selection and management.