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Peak aortic jet velocity as a predictor of short- and long-term outcomes following percutaneous coronary intervention
Takamasa Iwai1, Kensuke Takagi1, Takeshi Kitai1
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Insights
Aortic valve stenosis (AS) significantly increases mortality and major adverse cardiovascular events (MACE) in patients undergoing percutaneous coronary intervention (PCI). Peak aortic jet velocity (AV-Vel) stratification reveals worse outcomes with moderate to severe AS.
Area of Science:
- Cardiology
- Interventional Cardiology
- Valvular Heart Disease
Background:
- Coronary artery disease (CAD) and aortic valve stenosis (AS) frequently coexist.
- AS can worsen myocardial ischemia and negatively impact patient prognosis.
- Understanding the combined impact is crucial for patient management.
Purpose of the Study:
- To evaluate the prognostic significance of AS, stratified by peak aortic jet velocity (AV-Vel), in patients undergoing percutaneous coronary intervention (PCI).
- To assess the impact of AS on mortality and major adverse cardiovascular events (MACE) after PCI.
Main Methods:
- Retrospective, multicenter observational study of 9,690 patients undergoing PCI (April 2013-March 2019).
- Patients categorized into non-AS and AS groups; AS group further stratified by AV-Vel (mild, moderate, severe).
- Primary outcome: all-cause mortality. Secondary outcome: MACE (mortality, myocardial infarction, stroke). Survival analysis performed over 5 years.
Main Results:
- Patients with AS (n=361) had significantly higher rates of mortality (HR: 3.06) and MACE (HR: 2.45) compared to the non-AS group.
- Moderate and severe AS were associated with worse short-term outcomes (≤30 days) post-PCI.
- Mild to severe AS demonstrated significantly worse long-term outcomes over the 5-year follow-up period.
Conclusions:
- Peak aortic jet velocity (AV-Vel) is an independent predictor of both short- and long-term outcomes in patients undergoing PCI.
- The presence and severity of AS significantly impact prognosis after PCI.
- Stratification by AV-Vel aids in risk stratification for patients with coexisting CAD and AS undergoing PCI.
Background:
Coronary artery disease (CAD) and aortic valve stenosis (AS) often coexist, with AS exacerbating myocardial ischemia and affecting prognosis.
Aims:
To investigate the prognostic impact of AS stratified by peak aortic jet velocity (AV-Vel) in patients undergoing PCI.
Methods And Results:
We conducted retrospective multicenter observational study involving patients who underwent percutaneous coronary intervention (PCI) between April 2013 and March 2019. The patients were divided into non-AS group and AS group. The AS group was further categorized: 2.6 ≤ AV-Vel < 3.0 m/s, mild AS; 3.0 ≤ AV-Vel < 4.0 m/s, moderate AS; and AV-Vel ≥ 4.0 m/s, severe AS. The primary outcome was all-cause mortality, and the secondary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, myocardial infarction, or stroke. Multivariable Cox proportional hazards analysis was performed over 5-year observation period, with landmark analyses conducted at 30 days after PCI and from day 31 after PCI to 5 years. In total, 9,690 patients were analyzed (AS group, n = 361). Over a median follow-up of 2.57 (IQR: 0.89-4.24) years, AS group exhibited higher rates of mortality (HR: 3.06; 95% CI: 2.41-3.90; p < 0.001) and MACE (HR: 2.45; 95%CI: 1.97-3.04; p < 0.001) compared with non-AS group. Subgroup analysis revealed that patients with moderate and severe AS had worse short-term mortality and MACE within 30 days after PCI than the non-AS group, while patients with mild to severe AS showed significantly worse long-term outcomes than the non-AS group.
Conclusions:
AV-Vel is independently associated with both short- and long-term outcomes in patients undergoing PCI.
