Outcomes of complex, high-risk percutaneous coronary intervention in patients with severe aortic stenosis: the ASCoP
Claudio Montalto1,2, Andrea R Munafò1, Francesco Soriano1
1Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy.
Insights
Performing transcatheter aortic valve implantation (TAVI) and complex percutaneous coronary intervention (PCI) together increases adverse events. Staged procedures for TAVI and high-risk PCI are safer for patients needing both interventions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials
Background:
- Limited evidence exists for managing patients requiring both transcatheter aortic valve implantation (TAVI) and complex, high-risk percutaneous coronary intervention (PCI).
- Optimal timing for PCI in patients undergoing TAVI remains unclear, posing a clinical challenge.
Purpose of the Study:
- To evaluate and compare different strategies for the timing of percutaneous coronary intervention (PCI) in patients who have undergone or are undergoing transcatheter aortic valve implantation (TAVI).
- To assess the safety and efficacy of concomitant versus staged procedures for TAVI and complex/high-risk PCI.
Main Methods:
- The ASCoP registry retrospectively analyzed 519 patients indicated for both TAVI and complex/high-risk PCI.
- Primary endpoint: composite of all-cause death and unplanned cardiovascular rehospitalization.
- Secondary endpoint: composite of death, stroke, myocardial infarction, bleeding, vascular complications, and revascularization. Multivariable analysis was employed.
Main Results:
- Of 519 patients, 363 (69.9%) had staged procedures and 156 (30.1%) had concomitant TAVI and PCI.
- No significant difference in the primary endpoint between groups (p=0.98).
- The concomitant group experienced a higher rate of the secondary endpoint (25.8% vs 17.4%, p=0.014), indicating increased adverse events.
Conclusions:
- Concomitant TAVI and complex/high-risk PCI strategies are associated with a higher incidence of adverse events.
- Increased procedural risk is observed with simultaneous TAVI and complex/high-risk PCI.
- Staged procedures may offer a safer approach for patients requiring both interventions.
Background:
There is a lack of evidence to guide treatment of patients with a concomitant indication for transcatheter aortic valve implantation (TAVI) and complex, high-risk percutaneous coronary intervention (PCI).
Aims:
We aimed to assess different strategies of PCI timing in this high-risk TAVI cohort.
Methods:
The ASCoP registry retrospectively included patients with a clinical indication for both TAVI and PCI with at least 1 criterion of complex or high-risk PCI. The primary endpoint was a composite of all-cause death and unplanned rehospitalisation for cardiovascular causes. The secondary endpoint was a composite of all-cause death, stroke, acute myocardial infarction, major bleeding, major vascular complication and unplanned revascularisation. Multivariable analysis was used to adjust for possible confounders.
Results:
A total of 519 patients were included: 363 (69.9%) underwent staged procedures and 156 (30.1%) concomitant TAVI and PCI. After 441 (interquartile range 182-824) days, the primary endpoint occurred in 151 (36.5%) cases, without any significant difference between the 2 groups (p=0.98), while the secondary endpoint occurred more frequently in the concomitant group (n=36 [25.8%] vs n=57 [17.4%]; p=0.014).
Conclusions:
In patients undergoing TAVI and complex/high-risk PCI, a concomitant strategy is associated with a higher rate of adverse events and increased procedural risk. (ClinicalTrials.gov: NCT05750927).
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:22Aneurysm IV: Nursing Management