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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
A Propensity-Matched Analysis of Pre Versus Concomitant Percutaneous Coronary Intervention in Patients Undergoing
Avery Love1, Duc-Hieu Bui1, Shahman Shahab1
1Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
Background:
Percutaneous coronary intervention (PCI) is frequently performed in patients undergoing transcatheter aortic valve replacement (TAVR); however, the optimal timing of PCI remains uncertain, particularly in patients with frailty-related high-risk features. Evidence comparing pre-TAVR versus concomitant PCI strategies in this vulnerable population is limited.
Methods:
We conducted a retrospective cohort study using the TriNetX Research Network to identify patients with frailty-related high-risk features undergoing TAVR with either pre-TAVR PCI (3 months to 2 weeks before TAVR) or concomitant PCI (same day as TAVR). Propensity score matching (1:1) was performed using demographics, comorbidities, frailty-related features, and antiplatelet and anticoagulant therapy. The primary outcome was a 90-day composite including all-cause mortality, acute kidney injury, bleeding requiring transfusion, gastrointestinal bleeding, intracranial hemorrhage, acute coronary syndrome, and ischemic stroke. Secondary outcomes included the composite outcome at 30 days and 1 year, as well as individual components.
Results:
After propensity score matching, 361 patients were included in each group with adequate baseline balance. The primary 90-day composite outcome occurred in 27.4% of patients undergoing pre-TAVR PCI and 29.4% undergoing concomitant PCI (RR 1.07, 95% CI 0.85-1.35; p=0.56). At 30 days, the composite outcome occurred in 21.9% and 24.4% of patients, respectively (RR 1.11, 95% CI 0.85-1.45; p=0.43). At 1 year, the composite outcome occurred in 37.1% of the pre-TAVR PCI group and 38.5% of the concomitant PCI group (RR 1.04, 95% CI 0.86-1.25; p=0.70). No significant differences were observed in all-cause mortality at any time point.
Conclusions:
Among patients with frailty-related high-risk features undergoing TAVR, pre-TAVR PCI and concomitant PCI were associated with similar short- and longer-term clinical outcomes. No significant differences were observed in the 90-day composite outcome or all-cause mortality. These findings support an individualized approach to PCI timing in frail, high-risk patients.
