Laurent Faroux1, Francisco Campelo-Parada2, Erika Munoz-Garcia3, Luis Nombela-Franco4, Quentin Fischer5, Pierre Donaint6, Vicenç Serra7, Gabriela Veiga8, Enrique Gutiérrez9, Victoria Vilalta10, Alberto Alperi11, Ander Regueiro12, Lluis Asmarats13, Henrique B Ribeiro14, Anthony Matta2, Antonio Munoz-Garcia3, German Armijo4, Marina Urena5, Damien Metz6, Eduard Rodenas-Alesina7, Jose Maria de la Torre Hernandez8, Eduard Fernandez-Nofrerias10, Isaac Pascual11, Pedro Perez-Fuentes12, Dabit Arzamendi13, Diego Carter Campanha-Borges14, David Del Val1, Thomas Couture1, Josep Rodés-Cabau15. 1. Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. 2. Cardiology Department, Hôpital Universitaire de Toulouse, Toulouse, France. 3. Cardiology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain. 4. Cardiology Department, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain. 5. Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 6. Cardiology Department, Reims University Hospital, Reims, France. 7. Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 8. Cardiology Department, Hospital Marques de Valdecilla, Santander, Spain. 9. Cardiology Department, Hospital Gregorio Marañon, Madrid, Spain. 10. Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain. 11. Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 12. Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. 13. Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain. 14. Cardiology Department, Heart Institute, University of São Paulo, São Paulo, Brazil. 15. Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
Abstract
OBJECTIVES: This study sought to determine, in patients undergoing percutaneous coronary intervention (PCI) during the work-up pre-transcatheter aortic valve replacement (TAVR): 1) the clinical and peri-procedural PCI characteristics; 2) the long-term outcomes; and 3) the clinical events in those patients with complex coronary features. BACKGROUND: A PCI is performed in about 25% of TAVR candidates, but procedural features and late outcomes of pre-TAVR PCI remain largely unknown. METHODS: Multicenter study including 1197 consecutive patients who had PCI in the work-up pre-TAVR. A total of 1,705 lesions (1.5 ± 0.7 lesions per patient) were included. Death, stroke, myocardial infarction, and major adverse cardiovascular and cerebrovascular events (MACCE) were recorded, as well as target lesion failure (TLF) and target vessel failure (TVF). RESULTS: One-half of patients exhibited a multivessel disease and the mean SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) score was 12.1 ± 9.1. The lesions were of B2/C type, calcified, bifurcation, and ostial in 49.9%, 45.8%, 21.4%, and 19.3% of cases, respectively. After a median follow-up of 2 (interquartile range: 1 to 3) years, a total of 444 (37.1%) patients presented an MACCE. Forty patients exhibited TVF (3.3%), with TLF identified in 32 (2.7%) patients. By multivariable analysis, previous peripheral artery disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.002), atrial fibrillation (p = 0.003), diabetes mellitus (p = 0.012), and incomplete revascularization (p = 0.014) determined an increased risk of MACCE. In patients with unprotected left main or SYNTAX score >32 (n = 128), TLF, TVF, and MACCE rates were 3.9%, 6.3%, and 35.9%, respectively (p = 0.378; p = 0.065, and p = 0.847, respectively, vs. the rest of the population). CONCLUSIONS: Patients undergoing PCI in the work-up pre-TAVR frequently exhibited complex coronary lesions and multivessel disease. PCI was successful in most cases, and TLF and TVF rates at 2-year follow-up were low, also among patients with high-risk coronary features. However, overall MACCE occurred in about one-third of patients, with incomplete revascularization determining an increased risk. These results should inform future studies to better determine the optimal revascularization strategy pre-TAVR.
OBJECTIVES: This study sought to determine, in patients undergoing percutaneous coronary intervention (PCI) during the work-up pre-transcatheter aortic valve replacement (TAVR): 1) the clinical and peri-procedural PCI characteristics; 2) the long-term outcomes; and 3) the clinical events in those patients with complex coronary features. BACKGROUND: A PCI is performed in about 25% of TAVR candidates, but procedural features and late outcomes of pre-TAVR PCI remain largely unknown. METHODS: Multicenter study including 1197 consecutive patients who had PCI in the work-up pre-TAVR. A total of 1,705 lesions (1.5 ± 0.7 lesions per patient) were included. Death, stroke, myocardial infarction, and major adverse cardiovascular and cerebrovascular events (MACCE) were recorded, as well as target lesion failure (TLF) and target vessel failure (TVF). RESULTS: One-half of patients exhibited a multivessel disease and the mean SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) score was 12.1 ± 9.1. The lesions were of B2/C type, calcified, bifurcation, and ostial in 49.9%, 45.8%, 21.4%, and 19.3% of cases, respectively. After a median follow-up of 2 (interquartile range: 1 to 3) years, a total of 444 (37.1%) patients presented an MACCE. Forty patients exhibited TVF (3.3%), with TLF identified in 32 (2.7%) patients. By multivariable analysis, previous peripheral artery disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.002), atrial fibrillation (p = 0.003), diabetes mellitus (p = 0.012), and incomplete revascularization (p = 0.014) determined an increased risk of MACCE. In patients with unprotected left main or SYNTAX score >32 (n = 128), TLF, TVF, and MACCE rates were 3.9%, 6.3%, and 35.9%, respectively (p = 0.378; p = 0.065, and p = 0.847, respectively, vs. the rest of the population). CONCLUSIONS:Patients undergoing PCI in the work-up pre-TAVR frequently exhibited complex coronary lesions and multivessel disease. PCI was successful in most cases, and TLF and TVF rates at 2-year follow-up were low, also among patients with high-risk coronary features. However, overall MACCE occurred in about one-third of patients, with incomplete revascularization determining an increased risk. These results should inform future studies to better determine the optimal revascularization strategy pre-TAVR.