Giulio G Stefanini1, Enrico Cerrato2, Carlo Andrea Pivato3, Michael Joner4, Luca Testa5, Tobias Rheude4, Thomas Pilgrim6, Marco Pavani7, Jorn Brouwer8, Diego Lopez Otero9, Erika Munoz Garcia10, Marco Barbanti11, Luigi Biasco12, Ferdinando Varbella2, Bernhard Reimers13, Victor Alfonso Jimenez Diaz14, Massimo Leoncini15, Maria Luisa Salido Tahoces16, Alfonso Ielasi17, Jose M de la Torre Hernandez18, Darren Mylotte19, Philippe Garot20, Alaide Chieffo21, Luis Nombela-Franco22. 1. Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy. Electronic address: giulio.stefanini@gmail.com. 2. Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli, Turin, Italy. 3. Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy. 4. German Heart Center, Munich, Germany. 5. IRCSS Policlinico San Donato, Milan, Italy. 6. Bern University Hospital, Bern, Switzerland. 7. Mauriziano Hospital, Turin, Italy. 8. St. Antonius Hospital, Nieuwegein, the Netherlands. 9. Santiago Hospital, Santiago, Spain. 10. H.C.U. Virgen de la Victoria, Malaga, Spain. 11. AOU Policlinico "G. Rodolico - San Marco", Catania, Italy. 12. Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland. 13. Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy. 14. Hospital Álvaro Cunqueiro, Vigo, Spain. 15. SSD Cardiologia Interventistica Ospedale di Sanremo, Sanremo, Italy. 16. Ramón y Cajal Hospital, Madrid, Spain. 17. Sant'Ambrogio Clinical Institute, Milan, Italy; Seriate Hospital, Bergamo, Italy. 18. Hospital Universitario Marques de Valdecilla, Instituto e Investigación Sanitaria Valdecilla, Santander, Spain. 19. Galway University, Galway, Ireland. 20. Hopital Privé Jacques Cartier, Institut Cardiovasculaire Paris-Sud, Ramsay-Santé, Massy, France. 21. IRCCS San Raffaele Hospital, Milan, Italy. 22. Hospital Clínico Universitario San Carlos, Madrid, Spain.
Abstract
OBJECTIVES: This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR). BACKGROUND: Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated. METHODS: Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry. RESULTS: Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non-ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150). CONCLUSIONS: Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501).
OBJECTIVES: This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR). BACKGROUND:Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated. METHODS:Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry. RESULTS: Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non-ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150). CONCLUSIONS: Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501).
Authors: Arif A Khokhar; Francesco Ponticelli; Adriana Zlahoda-Huzior; Kailash Chandra; Rossella Ruggiero; Marco Toselli; Francesco Gallo; Alberto Cereda; Alessandro Sticchi; Alessandra Laricchia; Damiano Regazzoli; Antonio Mangieri; Bernhard Reimers; Simone Biscaglia; Carlo Tumscitz; Gianluca Campo; Ghada W Mikhail; Won-Keun Kim; Antonio Colombo; Dariusz Dudek; Francesco Giannini Journal: Front Cardiovasc Med Date: 2022-09-14