Unplanned Percutaneous Coronary Revascularization After TAVR: A Multicenter International Registry
Giulio G Stefanini, Enrico Cerrato, Carlo Andrea Pivato, Michael Joner, Luca Testa, Tobias Rheude, Thomas Pilgrim, Marco Pavani, Jorn Brouwer, Diego Lopez Otero, Erika Munoz Garcia, Marco Barbanti, Luigi Biasco, Ferdinando Varbella, Bernhard Reimers, Victor Alfonso Jimenez Diaz, Massimo Leoncini, Maria Luisa Salido Tahoces, Alfonso Ielasi, Jose M de la Torre Hernandez, Darren Mylotte, Philippe Garot, Alaide Chieffo, Luis Nombela-Franco, REVIVAL Investigators, Giulio G Stefanini, Enrico Cerrato, Carlo Andrea Pivato, Michael Joner, Luca Testa, Tobias Rheude, Thomas Pilgrim, Marco Pavani, Jorn Brouwer, Diego Lopez Otero, Erika Munoz Garcia, Marco Barbanti, Luigi Biasco, Ferdinando Varbella, Bernhard Reimers, Victor Alfonso Jimenez Diaz, Massimo Leoncini, Maria Luisa Salido Tahoces, Alfonso Ielasi, Jose M de la Torre Hernandez, Darren Mylotte, Philippe Garot, Alaide Chieffo, Luis Nombela-Franco, REVIVAL Investigators
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).
Keywords: percutaneous coronary intervention; transcatheter aortic valve replacement; unplanned revascularization.
Conflict of interest statement
Author Disclosures Dr. Stefanini has received institutional research grant support from Boston Scientific; and has received speaker/consultant fees from B. Braun, Biosensors, and Boston Scientific. Dr. Pilgrim has received research grants and personal fees from Biotronik and Boston Scientific; and has received personal fees from HighLife SAS. Dr. Nombela-Franco has served as proctor for Abbott and received speaker/consultant fees from Boston Scientific and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed