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TAVI plus PCI versus SAVR plus CABG: Long-term outcome of a multicentre-registry
A Stundl1,2, L Preuss3,4, A Prinzing5
1Department of Internal Medicine I, Cardiology, Klinikum Rechts Der Isar, TUM School of Medicine & Health, Technische Universität München, Munich, Germany.
Insights
For intermediate-risk patients with severe aortic stenosis and coronary artery disease, transcatheter aortic valve implantation plus percutaneous coronary intervention (TAVI+PCI) and surgical aortic valve replacement plus coronary artery bypass grafting (SAVR+CABG) show similar long-term outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Elderly patients with severe aortic stenosis (AS) often have concomitant coronary artery disease (CAD).
- Long-term outcomes for intermediate-risk patients undergoing TAVI+PCI versus SAVR+CABG remain unclear.
- This study focuses on intermediate-risk AS-CAD patients (logistic EuroSCORE 10-20%, EuroSCORE II 4-9%).
Purpose of the Study:
- To compare the long-term outcomes of TAVI+PCI versus SAVR+CABG in intermediate-risk AS-CAD patients.
- To evaluate differences in mortality, complications, and overall survival between the two treatment strategies.
Main Methods:
- Retrospective multicentre study including 366 patients (2012-2020).
- 211 patients underwent TAVI+PCI, and 155 received SAVR+CABG.
- Primary endpoint: all-cause mortality up to three years; secondary outcomes followed VARC-3 criteria.
Main Results:
- At three years, mortality was higher after TAVI+PCI (37.1%) compared to SAVR+CABG (25.5%), p=0.02.
- However, CAD complexity was greater in the SAVR+CABG group (SYNTAX Score 22.2 vs. 15.9).
- After propensity score matching, 3-year mortality did not differ significantly (33.8% vs. 25.9%, p=0.14), and surgical patients had more early complications.
Conclusions:
- TAVI+PCI and SAVR+CABG yield comparable long-term outcomes in intermediate-risk AS-CAD patients.
- While surgery led to more early complications, there was a trend towards improved long-term survival with SAVR+CABG.
- The choice of treatment should consider individual patient factors and procedural risks.
Background:
In elderly patients with severe aortic stenosis (AS), concomitant coronary artery disease (CAD) is common. Escpecially for intermediate-risk patients eligible for both interventional and surgical treatment, long-term benefit of either approach remains unclear.
Objectives:
To compare long-term outcomes of TAVI + PCI versus SAVR + CABG in intermediate-risk AS-CAD patients (logistic EuroSCORE 10-20%, EuroSCORE II 4-9%).
Methods:
This retrospective multicentre study included 366 patients treated between 2012 and 2020: 211 underwent TAVI + PCI and 155 received SAVR + CABG. The primary endpoint was all-cause mortality up to three years; secondary outcomes followed VARC-3 criteria.
Results:
Mortality rates were similar at 30 days (4.8% vs. 8.4%, p = 0.16), six months (12.4% each), one year (18.1% vs. 15.7%) and two years (24.9% vs. 20.1%). At three years, mortality was higher after TAVI + PCI (37.1% vs. 25.5%, p = 0.02), though CAD complexity was greater in the SAVR + CABG group (SYNTAX Score 22.2 vs. 15.9, p < 0.001). TAVI + PCI patients were older (81.1 vs. 78.5 years, p < 0.001), but surgical risk was comparable (EuroSCORE II 6.4% vs. 6.2%). Surgical patients experienced more complications, including delirium, stroke, acute kidney injury, major bleedings and transfusion needs. After propensity score matching (154 patients per group), 3-year mortality no longer differed significantly (33.8% vs. 25.9%, p = 0.14).
Conclusion:
Both TAVI + PCI and SAVR + CABG yield comparable long-term outcomes in intermediate-risk AS-CAD patients. Although early complications were more common with surgery, there was a trend towards improved long-term survival.
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