Comparison of Outcomes of Transcatheter Aortic Valve Replacement Plus Percutaneous Coronary Intervention Versus Transcatheter Aortic Valve Replacement Alone in the United States

Singh, Vikas; Rodriguez, Alex P.; Thakkar, Badal; Patel, Nileshkumar; Ghatak, Abhijit; Badheka, Apurva; Alfonso, Carlos; Marchena, Eduardo de; Sakhuja, Rahul; Inglessis‐Azuaje, Ignacio; Palacios, Igor F.; Cohen, Mauricio G.; Elmariah, Sammy; O’Neill, William W.

doi:10.1016/j.amjcard.2016.08.048

Cited by 39 publications

(22 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 24 observational studies including 7128 participants met the inclusion criteria for the systematic review; among these, 9 studies met criteria for the meta‐analysis, evaluating 3858 participants (Figure ) of which 983 underwent TAVI with PCI revascularization strategy. The mean age was 85.3 years and 48.4% were female in 14 studies that reported both age and gender .…”

Section: Resultsmentioning

confidence: 99%

“…Crude all‐cause 30‐day mortality was reported in 18 studies and occurred in 6.97% (368/5281) of patients; crude cardiovascular 30‐day mortality was reported in 5 studies and occurred in 5.0% (52/1046) of patients. At 30 days, the crude incidence of MI was reported in 9 studies and occurred in 0.8% (26/3109) of patients, major or life‐threatening bleeding was reported in 12 studies and occurred in 14.5% (590/4074) of patients, and AKI was reported in 13 studies and occurred in 6.04% (259/4288) of patients.…”

Section: Resultsmentioning

confidence: 99%

“…Notably, although most of the included studies were small and reported neutral results, Singh et al presented a large sample size and reported adverse outcomes with PCI. In addition, the 95% CIs of all the studies except that of Singh et al overlap 1 (Figure ), and the 95% CIs of the overall effect estimate do not overlap 1.…”

Section: Resultsmentioning

confidence: 99%

“…As such, this study was excluded from our meta‐analysis. Singh and colleagues showed worse 30‐day outcomes when PCI was performed during the same admission, although, as above mentioned, this observation might have been driven by the difference in the reported prevalence of CAD between groups or by a questionable definition of CAD using International Classification of Diseases, Ninth Revision coding. Higher 30‐day mortality could also be associated with a higher preoperative risk profile, meaning that the PCI group may have been a higher risk cohort, translating into worse outcome; however, the authors did not report adjusting for preprocedural risk scoring.…”

Section: Discussionmentioning

confidence: 96%

See 3 more Smart Citations

Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta‐Analysis

Kotronias

Kwok

George

et al. 2017

JAHA

138

View full text Add to dashboard Cite

BackgroundRecent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta‐analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation.Methods and ResultsWe conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random‐effects meta‐analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta‐analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95% confidence interval [CI], 1.33–2.60; P=0.0003) and higher 30‐day mortality (OR: 1.42; 95% CI, 1.08–1.87; P=0.01). There were no differences in effect estimates for 30‐day cardiovascular mortality (OR: 1.03; 95% CI, 0.35–2.99), myocardial infarction (OR: 0.86; 95% CI, 0.14–5.28), acute kidney injury (OR: 0.89; 95% CI, 0.42–1.88), stroke (OR: 1.07; 95% CI, 0.38–2.97), or 1‐year mortality (OR: 1.05; 95% CI, 0.71–1.56). The timing of percutaneous coronary intervention (same setting versus a priori) did not negatively influence outcomes.ConclusionsOur analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient‐important clinical outcomes and may be associated with an increased risk of major vascular complications and 30‐day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

See 2 more Smart Citations

Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta‐Analysis

Kotronias

Kwok

George

et al. 2017

JAHA

138

View full text Add to dashboard Cite

show abstract

“…Transcatheter aortic valve replacement (TAVR) has become an established therapeutic option for patients with symptomatic, severe aortic stenosis (AS) who are ineligible or at higher risk for conventional cardiac surgery [1][2][3][4]. In recent years, TAVR is also been increasingly used to treat patients with a lower risk profile; this practice is supported by results from the NOTION, PARTNER-II, and SURTAVI Abbreviations: ACC, American College of Cardiology; AS, aortic stenosis; ASA, acetylsalicylic acid; AVR, aortic valve replacement; CABG, coronary artery bypass graft; CAD, coronary artery disease; CAG, coronary angiography; CTO, chronic total occlusion; FFR, fractional flow reserve; MSCT, multislice computed tomography; RCT, randomized controlled trial; RV, revascularization; STS, Society of Thoracic Surgeons; PCI, percutaneous coronary intervention; SAVR, surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement; THV, transcatheter heart valve; VD, vessel disease.…”

Section: Introductionmentioning

confidence: 99%

Coronary artery disease, revascularization, and clinical outcomes in transcatheter aortic valve replacement: Real‐world results from the East Denmark Heart Registry

Millán-Iturbe

Sawaya

Lønborg

et al. 2017

Cathet Cardio Intervent

View full text Add to dashboard Cite

Transcatheter aortic valve replacement (TAVR) has become an established therapeutic option for patients with symptomatic, severe aortic stenosis. The optimal treatment strategy for concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. This study aimed to describe the degree of CAD, revascularization strategies, and long-term clinical outcomes in a large-scale all-comers TAVR-population. Nine hundred and forty-four consecutive patients underwent TAVR. Obstructive CAD was reported in 224 patients (23.7%)-of these, 150 (66.9%) presented with one-vessel disease (1-VD), 51 (22.8%) with 2-VD, and 23 (10.3%) with 3-VD. Two-thirds underwent coronary revascularization before TAVR; half of those patients with 1-VD and only one-third of those with multivessel disease were completely revascularized. In general, borderline stenoses (50%-70%) were more frequently revascularized in proximal coronary segments than in more distal segments. Long-term survival rates by Kaplan-Meier analysis of the total TAVR population at 5 and 9 years were 64.7% and 54.1%, respectively. A diagnostic coronary angiography was performed in 16.5% of patients within 5 years after TAVR; only 4.8% underwent consequent percutaneous coronary intervention (PCI). There was no difference in survival and need for revascularization post-TAVR between those patients with or without obstructive CAD ± revascularization. Neither was there a survival difference between those with or without previous CABG and/or chronic total occlusion(s). In conclusion, CAD is prevalent in TAVR patients and pre-TAVR coronary revascularization is typically focused on treating proximal and high-grade stenosis. A selective pre-TAVR PCI strategy results in favorable clinical outcomes with very low rates of post-TAVR coronary revascularization.

show abstract

Influence of coronary artery disease and percutaneous coronary intervention on mid‐term outcomes in patients with aortic valve stenosis treated with transcatheter aortic valve implantation

Kaihara

Higuma

Izumo

et al. 2021

Clinical Cardiology

View full text Add to dashboard Cite

Background A high frequency of coronary artery disease (CAD) is reported in patients with severe aortic valve stenosis (AS) who undergo transcatheter aortic valve implantation (TAVI). However, the optimal management of CAD in these patients remains unknown. Hypothesis We hypothesis that AS patients with TAVI complicated by CAD have poor prognosis. His study evaluates the prognoses of patients with CAD and severe AS after TAVI. Methods We divided 186 patients with severe AS undergoing TAVI into three groups: those with CAD involving the left main coronary (LM) or proximal left anterior descending artery (LAD) lesion (the CAD[LADp] group), those with CAD not involving the LM or a LAD proximal lesion (the CAD[non‐LADp] group), and those without CAD (Non‐CAD group). Clinical outcomes were compared among the three groups. Results The CAD[LADp] group showed a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) and all‐cause mortality than the other two groups (log‐rank p = .001 and p = .008, respectively). Even after adjustment for STS score and percutaneous coronary intervention (PCI) before TAVI, CAD[LADp] remained associated with MACCE and all‐cause mortality. However, PCI for an LM or LAD proximal lesion pre‐TAVI did not reduce the risk of these outcomes. Conclusions CAD with an LM or LAD proximal lesion is a strong independent predictor of mid‐term MACCEs and all‐cause mortality in patients with severe AS treated with TAVI. PCI before TAVI did not influence the outcomes.

show abstract

Comparison of Outcomes of Transcatheter Aortic Valve Replacement Plus Percutaneous Coronary Intervention Versus Transcatheter Aortic Valve Replacement Alone in the United States

Cited by 39 publications

References 16 publications

Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta‐Analysis

Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta‐Analysis

Coronary artery disease, revascularization, and clinical outcomes in transcatheter aortic valve replacement: Real‐world results from the East Denmark Heart Registry

Influence of coronary artery disease and percutaneous coronary intervention on mid‐term outcomes in patients with aortic valve stenosis treated with transcatheter aortic valve implantation

Contact Info

Product

Resources

About