Comparison of Outcomes in Patients Having Isolated Transcatheter Aortic Valve Implantation Versus Combined With Preprocedural Percutaneous Coronary Intervention

Abdel‐Wahab, Mohamed; Mostafa, Ahmad E.; Geist, Volker; Stöcker, Björn; Gordian, Ken; Merten, Constanze; Richardt, Doreen; Töelg, Ralph; Richardt, Gert

doi:10.1016/j.amjcard.2011.09.053

Cited by 133 publications

(75 citation statements)

References 12 publications

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“…Eight studies(34, 50–56) qualitatively reported improvement in NYHA class after TAVR. In 51 studies with quantitative data, a substantial variation in the mean change in NYHA class was observed (Figure 1 and Appendix Figure 3).…”

Section: Resultsmentioning

confidence: 99%

Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement

et al. 2014

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Background Transcatheter aortic valve replacement (TAVR) prolongs survival in high-risk patients with severe aortic stenosis. However, its functional and quality-of-life benefits have not been established. Purpose To evaluate the changes in functional status and quality of life after TAVR. Data Sources MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from January 1, 2002, to September 30, 2013. Study Selection Studies of TAVR that reported the New York Heart Association (NYHA) class, Short-Form (SF)-12/36 physical and mental component summary (points), or other measures of functional status. Data Extraction Two reviewers independently extracted the mean change (follow-up – baseline) in primary outcomes. Due to substantial heterogeneity, data were not pooled; the range (minimum, maximum) of mean change was summarized. Data Synthesis We identified 60 observational studies (56 pre-post comparison and 4 head-to-head comparative studies) and 2 randomized controlled trials (11,205 patients). Most studies showed a clinically important decrease in NYHA class at 6–11 months (range: −0.8, −2.1), 12–23 months (−0.8, −2.1), 24–35 months (−1.2, −2.6), and ≥36 months (−1.2, −1.6). The improvement in SF-12/36 physical component score was clinically important over 12 months (4.9, 26.9), while the change in mental component score was smaller (1.0, 8.9). Clinically important improvements were observed in other disease-specific measures and 6-minute walk test, but less consistently seen in general health measures. Limitations Comparative evidence is limited by few head-to-head studies of functional outcomes. Survivor bias may have overestimated the benefits. Conclusions TAVR provides clinically important benefits in physical function and disease-specific measures of quality of life, but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision-making.

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Section: Resultsmentioning

confidence: 99%

Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement

et al. 2014

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“…27 The present study had certain limitations. This was a large study conducted in a quaternary care hospital system, and results may not be generalizable to all patients with radiation-associated CAD treated with PCI.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Mortality in Patients With Radiation-Associated Coronary Artery Disease Treated With Percutaneous Coronary Intervention

Reed

Masri

Griffin

et al. 2016

Circ: Cardiovascular Interventions

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“…Abdel Wahab et al . reported that 55 patients who underwent PCI prior to TAVI showed no difference in adverse events at either 30 days (2% versus 6%; P = 0.27) or 6 months (9% versus 14%; P = 0.42) when compared to a group undergoing isolated TAVI [26]. The feasibility of PCI for CAD in patients with severe AS has been demonstrated by Goel et al .…”

Section: Introductionmentioning

confidence: 99%

The percutaneous coronary intervention prior to transcatheter aortic valve implantation (ACTIVATION) trial: study protocol for a randomized controlled trial

Khawaja

Wang

Pocock

et al. 2014

Trials

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BackgroundCurrent guidelines recommend treatment of significant coronary artery disease by concomitant coronary artery bypass grafting (CABG) in patients undergoing surgical aortic valve replacement. However there is no consensus as to how best to treat coronary disease in high-risk patients requiring transcatheter aortic valve implantation (TAVI).Methods/DesignThe percutaneous coronary intervention prior to transcatheter aortic valve implantation (ACTIVATION) trial is a randomized, controlled open-label trial of 310 patients randomized to treatment of significant coronary artery disease by percutaneous coronary intervention (PCI - test arm) or no PCI (control arm). Significant coronary disease is defined as ≥1 lesion of ≥70% severity in a major epicardial vessel or 50% in a vein graft or protected left main stem lesion. The trial tests the hypothesis that the strategy of performing pre-TAVI PCI is non-inferior to not treating such coronary stenoses with PCI prior to TAVI, with a composite primary outcome of 12-month mortality and rehospitalization. Secondary outcomes include efficacy end-points such as 30-day mortality, safety endpoints including bleeding, burden of symptoms, and quality of life (assessed using the Seattle Angina Questionnaire and the Kansas City Cardiomyopathy Questionnaire).In conclusion, we hope that using a definition of coronary artery disease severity closer to that used in everyday practice by interventional cardiologists - rather than the 50% severity used in surgical guidelines - will provide robust evidence to direct guidelines regarding TAVI therapy and improve its safety and efficacy profile of this developing technique.Trial registrationISRCTN75836930, http://www.controlled-trials.com/ISRCTN75836930 (registered 19 November 2011).

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Comparison of Outcomes in Patients Having Isolated Transcatheter Aortic Valve Implantation Versus Combined With Preprocedural Percutaneous Coronary Intervention

Cited by 133 publications

References 12 publications

Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement

Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement

Long-Term Mortality in Patients With Radiation-Associated Coronary Artery Disease Treated With Percutaneous Coronary Intervention

The percutaneous coronary intervention prior to transcatheter aortic valve implantation (ACTIVATION) trial: study protocol for a randomized controlled trial

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