Timing and Outcomes of PCI in Conjunction With TAVR With Balloon-Expandable Valves

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Optimal timing for percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) remains a significant clinical question.
• Stable coronary artery disease (CAD) management in TAVR candidates requires careful consideration of procedural sequencing.

Purpose of the Study:

• To compare clinical outcomes based on the timing of PCI relative to TAVR in patients with stable CAD.
• Evaluate the impact of PCI timing on mortality, stroke, and complications in the TAVR population.

Main Methods:

• Analysis of a large cohort (51,480 patients) from the STS/ACC TVT Registry and Medicare Linkage (2015-2023).
• Focus on patients undergoing PCI and TAVR with the SAPIEN 3 valve, with PCI within ±90 days of TAVR.
• Propensity-matched analysis to compare outcomes up to 3 years post-procedure, including all-cause mortality and stroke.

Main Results:

• PCI performed within 90 days before TAVR was associated with significantly lower all-cause mortality (38.1% vs 38.8%) and a composite of mortality and stroke (42.8% vs 43.5%) at 3 years compared to concomitant PCI.
• Concomitant PCI and TAVR procedures resulted in higher rates of major vascular complications (2% vs 1.4%).

Conclusions:

• Performing PCI within 90 days prior to TAVR appears to be associated with improved survival and reduced composite outcomes compared to concomitant procedures.
• Concomitant PCI and TAVR increases the risk of major vascular complications and slightly elevates the composite endpoint of mortality and stroke.