SPC365

Differences in outcomes between percutaneous coronary intervention of coronary lesions and medical therapy in patients undergoing transcatheter aortic valve implantation

Session: Comunicações Orais - Sessão 03 - Válvula aórtica percutânea
Speaker: Ricardo Carvalheiro

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: Ricardo Da Silva Carvalheiro; Bárbara Teixeira; Francisco Albuquerque; Fernando Ferreira; Miguel Figueiredo; André Grazina; Inês Rodrigues; Tiago Mendonça; António Fiarresga; Ruben Ramos; Duarte Cacela

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">For patients with stable coronary artery disease (CAD) and severe aortic stenosis considered suitable for percutaneous treatment, the conventional practice has been to perform percutaneous coronary intervention (PCI) on bystander severe proximal lesions before undergoing transcatheter aortic valve implantation (TAVI) <span style="color:#0f0f0f">due to concerns regarding coronary access after prosthesis placement</span>,<span style="color:#0f0f0f"> despite the lack of robust evidence regarding reductions in cardiovascular mortality.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#0f0f0f">Objectives: </span></span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#0f0f0f">We sought to compare a strategy of planned periprocedural revascularization of obstructive coronary lesions versus medical therapy in patients undergoing TAVI, regarding major cardiovascular events (MACE), cardiovascular and all cause mortality and unplanned revascularization after TAVI.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#0f0f0f">Methods: </span></span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">We performed a retrospective analysis of patients with significant coronary artery disease (defined as &ge; 70% obstruction in an epicardial vessel with &ge; 2mm diameter or &ge; 50% obstruction in the left main coronary artery) submitted to TAVI in a high-volume Portuguese tertiary center from 2009 to 2022. Pts were divided in two groups according to treatment with a previously planned periprocedural (&lt;6 months before or concomitantly) PCI or medical therapy. Comparison of groups was made using Chi-square, t-test and Mann-Whitney analysis. Primary endpoint was defined as time to cardiovascular death and all-cause mortality of last follow-up over 2 years after TAVI. Kaplan Meier survival curves were used to estimate the risk of events.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Results: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">A total of 162 pts (48.1% female) were included, with a mean age of 82 &plusmn; 5.9 years and a median follow-up of 24 months. 78 pts (48.1%) were submitted to planned periprocedural PCI and 84 pts (51.9%) were treated with medical therapy. Pts submitted to PCI were more likely to have dyslipidaemia (p=0.038), pulmonary disease (p=0.018) and angina CCS class &ge; 1 (p=0.022). There were no differences between the groups regarding number of vessels involved, significant left main disease (p=0.574) or proximal left anterior descending disease (p=0.310). There were no statistically significant differences between the groups regarding 30-day MACE (p=0.673), 30-day CV deaths (log rank p = 0.067) or 30-day all-cause mortality (log rank p = 0.089). Regarding long term follow-up, pts submitted to periprocedural PCI had statistically significant higher CV-death at 48 months (log rank p = 0.034) with a HR of 2.7 (95% CI (1.037 &ndash; 6.890), p = 0,042). There were no statistically significant differences regarding unplanned revascularization (p=0.498) or all-cause mortality at 48 months (log rank p = 0.500).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusions: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">In our cohort of patients, periprocedural PCI was associated with higher CV death at 48 months after TAVI. There were no statistically significant differences regarding 30-day outcomes, need for unplanned revascularization or all-cause mortality at 48 months</span>.</span></span></p>