Author + information
- Ashwat S. Dhillon,
- Noor Al-Asady,
- David M. Shavelle,
- Ray V. Matthews and
- Leonardo C. Clavijo
A significant proportion of patients with severe aortic stenosis (AS) have coexisting significant coronary artery disease (CAD). There is limited data regarding outcomes of percutaneous coronary intervention (PCI) prior to transcatheter aortic valve replacement (TAVR) in patients with severe AS and significant CAD. We sought to assess clinical outcomes in patients with severe AS who underwent PCI within 30 days prior to TAVR.
286 consecutive patients were identified who underwent TAVR from 5/31/2011 to 2/4/2016. Of these, 29 patients underwent PCI for CAD within 30 days prior to TAVR (PCI+TAVR group). We matched these patients in a 1:1 fashion (based on age, gender, prior myocardial infarction and left ventricular ejection fraction) with 29 consecutive non-AS patients who underwent PCI for CAD (PCI group) during the same time period. Primary end-point was a composite outcome of major adverse cardiovascular events (including myocardial infarction and stroke), all-cause mortality and readmissions, all within 30 days. Continuous variables were analyzed using t-test and categorical variables were analyzed using Fisher’s exact test.
The study population consisted of 58 patients or 29 pairs (69% male, mean age 77±11 years) who were well matched for baseline clinical characteristics. At 30 days, 7/29 patients in each group met the primary end-point (p=1.0). The PCI+TAVR and PCI-alone group had no statistically significant difference in the primary end-point at 30 days.
PCI prior to TAVR in patients with severe AS and significant CAD appears to be feasible and safe. At 30 days follow-up, no significant differences were seen in mortality, major adverse cardiovascular events or readmissions in patients with severe AS and significant CAD who underwent PCI within 30 days prior to TAVR compared to non-AS patients with CAD who underwent PCI alone. Further population-based studies are needed to assess the safety of PCI prior to TAVR.