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Updated: Jan 17, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Clinical outcomes of percutaneous coronary interventions after transcatheter aortic valve replacement
Carlo A Pivato1,2, Ottavia Cozzi1,2, Nicole Fontana3,4
1Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy.
Insights
Patients undergoing percutaneous coronary intervention (PCI) after transcatheter aortic valve replacement (TAVR) face higher risks of major adverse cardiovascular events (MACE). Careful patient selection is crucial for PCI in TAVR patients with coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter aortic valve replacement (TAVR) is increasingly common.
- Percutaneous coronary intervention (PCI) is frequently performed in patients with coronary artery disease.
- The prognosis of patients undergoing PCI after TAVR is not well understood.
Purpose of the Study:
- To compare the prognosis of patients undergoing PCI after TAVR versus those undergoing PCI without prior TAVR.
- To identify risk factors for major adverse cardiovascular events (MACE) in this population.
Main Methods:
- Retrospective comparison of consecutive PCI patients with and without prior TAVR (2008-2023).
- Kaplan-Meier analysis for 1-year MACE (cardiovascular death or myocardial infarction).
- Entropy balance and weighted Cox regression for adjusted hazard ratios (HRs).
Main Results:
- Patients with prior TAVR (n=420) were older and had a higher 1-year MACE rate (8.7%) compared to those without (n=1197, 3.7%).
- Adjusted HR for MACE was 2.36 (P=0.032) in the prior TAVR group.
- Higher cardiovascular death risk (adjusted HR 3.12, P=0.032) drove the MACE association; myocardial infarction risk was not significant post-adjustment.
Conclusions:
- PCI after TAVR is associated with increased MACE risk, primarily driven by cardiovascular death.
- Accurate patient selection is critical for PCI in TAVR patients with coronary artery disease.
- Further research is needed to optimize management strategies for this growing patient cohort.
Aims:
The number of patients undergoing percutaneous coronary interventions (PCI) after transcatheter aortic valve replacement (TAVR) is expected to increase, but their prognosis remains poorly understood.
Methods And Results:
Consecutive PCI patients with prior TAVR were compared to patients without prior TAVR between 2008 and 2023. The Kaplan-Meier method was used to estimate the 1-year incidence of major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death or myocardial infarction. An entropy balance approach was implemented to adjust for imbalances in patient and procedural characteristics. Adjusted hazard ratios (HRs) were estimated using weighted Cox regression models. Comparing 420 PCI patients with prior TAVR (mean age 80.8 years, 37.1% women) to 1197 without (mean age 70.4 years, 24.6% women), 1-year MACE was higher in the prior TAVR group (8.7 vs. 3.7%; unadjusted HR 2.35, 95% CI 1.49-3.69; P < 0.001). After adjustment for clinical and procedural characteristics, prior TAVR remained associated with an increased risk of MACE (adjusted HR 2.36, 95% CI 1.08-5.16; P = 0.032). This was primarily driven by higher cardiovascular death (adjusted HR 3.12, 95% CI 1.10-8.79, P = 0.032), while the association with myocardial infarction was attenuated post-adjustment and no longer statistically significant.
Conclusion:
Patients undergoing PCI after TAVR experience a higher incidence of MACE compared to those undergoing PCI without prior TAVR, underscoring the importance of accurate patient selection before performing PCI in patients with chronic coronary syndrome and history of TAVR.
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