Timing of staged percutaneous coronary intervention before transcatheter aortic valve implantation.

Abstract

Significant coronary artery disease is highly prevalent in patients who underwent transcatheter aortic valve implantation (TAVI). Timing of staged percutaneous coronary intervention (PCI) in TAVI candidates remains debated. The present study assessed the impact of timing of the staged PCI on TAVI outcomes. Ninety-six patients (age 81 ± 5 years, 57% men) who had undergone staged PCI within 1 year before TAVI were included. The population was dichotomized according to the median time elapsed between PCI and TAVI (<30 and ≥30 days). In-hospital events and 30-day outcomes after TAVI were defined according to Valve Academic Research Consortium-2 definitions. Forty-eight patients underwent PCI <30 days and 48 patients underwent PCI ≥30 days before TAVI. Patients treated with PCI <30 days had lower hemoglobin levels at baseline (7.2 ± 0.9 mmol/L vs 7.9 ± 0.9 mmol/L, p = 0.002), more frequently atrial fibrillation (27% vs 13%, p = 0.018), and a shorter time interval between computed tomography acquisition and TAVI (7 days [2 to 10] vs 22 days [6 to 39], p <0.001) than their counterparts. Minor bleedings (13% vs 0%, p = 0.011) and overall vascular injury (27% vs 8%, p = 0.016 [minor injury: 17% vs 2%, p = 0.014; major injury: 10% vs 6%, p = 0.460]) were more frequently recorded in patients with staged PCI <30 days before TAVI. There were no differences in the incidence of other events and in 2-year survival. In conclusion, shortly (<30 days) or remote (≥30 days) staged PCI before TAVI resulted in comparable outcomes with the exception of minor vascular injury and minor bleeding events which were more frequently observed in patients treated with shortly staged PCI.

• Authors: Philippe J van Rosendael, Frank van der Kley, Vasileios Kamperidis, Spyridon Katsanos, Ibtihal Al Amri, Madelien Regeer, Martin J Schalij, Nina Ajmone Marsan, Jeroen J Bax, Victoria Delgado
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 115 Issue 12 Pg. 1726-32 (Jun 15 2015) ISSN: 1879-1913 [Electronic] United States
• PMID: 25890631 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Contrast Media
• iomeprol
• Iopamidol

Topics

• Aged, 80 and over
• Aortic Valve Stenosis (diagnostic imaging, surgery)
• Bioprosthesis
• Contrast Media
• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging, surgery)
• Female
• Humans
• Iopamidol (analogs & derivatives)
• Male
• Multidetector Computed Tomography
• Percutaneous Coronary Intervention (methods)
• Postoperative Complications
• Prosthesis Failure
• Retrospective Studies
• Survival Rate
• Transcatheter Aortic Valve Replacement
• Treatment Outcome