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Complete Versus Incomplete Revascularization in Patients With Severe Aortic Stenosis Undergoing Complex, High-Risk
Francesco Tartaglia1,2, Antonio Mangieri2, Andrea R Munafò3
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Insights
Complete revascularization in patients undergoing complex high-risk indicated percutaneous coronary intervention (CHIP) and transcatheter aortic valve implantation (TAVI) reduced cardiovascular hospitalizations but not overall mortality at one year.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Complex coronary artery disease (CAD) often coexists with severe aortic stenosis (AS).
- The impact of complete revascularization (CR) versus incomplete revascularization (IR) in patients undergoing both complex/high-risk indicated percutaneous coronary intervention (CHIP) and transcatheter aortic valve implantation (TAVI) is not well understood.
Purpose of the Study:
- To evaluate the prognostic impact of CR versus IR in patients who underwent both CHIP and TAVI.
Main Methods:
- A total of 550 patients undergoing CHIP and transfemoral TAVI between 2013 and 2023 were analyzed.
- Patients were stratified based on the completeness of coronary revascularization (CR vs. IR).
- The primary endpoint was a composite of all-cause death and unplanned cardiovascular (CV) hospitalization at 1 year.
Main Results:
- Complete revascularization (CR) was achieved in 54.4% of patients.
- Short-term outcomes were similar between CR and IR groups.
- At 1 year, the primary endpoint did not differ significantly between CR and IR groups (20.1% vs. 27.3%).
- However, cardiovascular rehospitalizations were significantly reduced in the CR group (14.8% vs. 22.8%) even after multivariable adjustment.
Conclusions:
- In patients undergoing CHIP and TAVI, complete revascularization (CR) is associated with a reduction in cardiovascular hospitalizations.
- Further research is warranted to confirm these findings and explore their clinical implications.
Background:
Complex coronary artery disease frequently coexists with severe aortic stenosis. The prognostic impact of complete revascularization (CR) versus incomplete revascularization (IR) in patients undergoing complex and/or high-risk indicated percutaneous coronary intervention (CHIP) and transcatheter aortic valve implantation (TAVI) remains unclear.
Methods:
We analyzed 550 patients who underwent CHIP and transfemoral TAVI between 2013 and 2023 at 14 international centers. Patients were stratified by completeness of revascularization. The primary endpoint was a composite of all-cause death and unplanned cardiovascular (CV) hospitalization at 1 year.
Results:
CR was achieved in 299 patients (54.4%). Patients with IR more frequently had three-vessel disease, bifurcation lesions, left main disease, and need for mechanical support. Balloon-expandable valves were more frequently implanted in the CR cohort. Short-term outcomes were similar in the two groups. At 1 year, the incidence of the primary endpoint did not differ significantly between CR and IR groups (20.1 vs. 27.3%, hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.49-1.07). CV rehospitalizations were significantly reduced in the CR group (14.8 vs. 22.8%, HR 0.61, 95% CI 0.38-0.97) even after multivariable adjustment and excluding hospitalizations for repeat revascularization.
Conclusions:
In patients undergoing CHIP and TAVI, CR was associated with a reduction in CV hospitalizations. Further studies are needed to confirm this finding.
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