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Timing of PCI in TAVR Patients Impact Clinical Outcomes
Session:
Comunicações Orais - Sessão 03 - Válvula aórtica percutânea
Speaker:
Catarina Oliveira
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Catarina Simões De Oliveira; Ana Margarida Martins; Ana Beatriz Garcia; Ana Abrantes; João Cravo; Marta Vilela; Cláudia Moreira Jorge; Miguel Nobre Menezes; João Silva Marques; Pedro Carrilho Ferreira; Pedro Pinto Cardoso; Fausto J. Pinto
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Aortic stenosis (AS) and coronary artery disease (CAD) share risk factors and frequently coexist. The optimal timing of percutaneous coronary intervention (PCI) in transaortic valve replacement (TAVR) patients (pts) is a matter of continuing debate. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong>: Compare the outcomes of pts with significant CAD submitted to TAVR according to the timing of PCI (preceding, concurrent or following TAVR). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Single-center study of consecutive pts referred for TAVR who had significant CAD and were submitted to PCI before, during or after TAVR procedure. The primary endpoint was defined as a composite of death from all causes, myocardial infarction (MI), stroke or hospitalization for heart failure (HF) in the follow-up (FUP). Significant CAD was defined as angiographic stenosis ?70% (or ?50% in unprotected left main). Descriptive and comparative statistical analysis were applied.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: 146 of the pts that underwent TAVR had severe CAD, of which 75% (n=107) were submitted to PCI. The median age was 82 years-old, 52.3% were male and the main co-morbidities were hypertension (91.6%), dyslipidemia (80.4%) and diabetes (44.9%). The mean left ventricle ejection fraction was 55%. Balloon-expandable valves were used in 68.2% pts. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Considering the PCI timing, 72.9% were performed before, 19.6% during and 7.5% after TAVR. Left main was the target of PCI in 12.1%, a proximal segment in 46.7% and medium or distal segment in 38.3% a (table 1). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">During a mean FUP of 36 months, the incidence of stroke was 3.8%, 15.9% had hospital admissions due to HF and 2.8% had MI. The primary endpoint was significantly more frequent in patients undergoing PCI in the same TAVR procedure (p=0.002). The lowest incidence of the primary endpoint was observed in pts undergoing PCI after TAVR (Figure 1). The incidence of acute renal lesion was not significantly different across different PCI timings (p=0.49). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">In multivariate analysis, concomitant PCI and TAVR was an independent predictor of the primary endpoint (p=0.049; HR 13, CI 1.016-167). </span></span></p> <p><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">: PCI performed in the same procedure as TAVR was independently associated with higher incidence of death, MI, stroke or HF re-hospitalization in the follow-up. Lowest incidence was observed when PCI was deferred and performed after TAVR. These results build to the growing evidence that simultaneous PCI in TAVR pts should be probably avoided. </span></span></p>
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