SPC365

Percutaneous coronary revascularization timing in patients undergoing transcatheter aortic valve implantation

Session: Sessão de Posters 47 - TAVI
Speaker: Ricardo Carvalheiro

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Ricardo Da Silva Carvalheiro; Francisco Albuquerqu; Bárbara Teixeira; 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">Percutaneous coronary revascularization (PCI) of bystander severe proximal lesions in patients undergoing transcatheter aortic valve implantation (TAVI) is common practice. Limited data exists regarding the best timing to perform PCI in such patients.</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">To investigate clinical and procedure-related outcomes of patients who underwent TAVI and planned PCI according to the timing of PCI in relation to the 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"><span style="color:#0f0f0f">P</span></span><span style="font-family:&quot;Arial&quot;,sans-serif">atients undergoing TAVI and a planned coronary revascularization strategy of bystander stable coronary lesions in a high-volume Portuguese tertiary centre from 2009 to 2022 were included. Significant coronary artery disease was defined as &ge; 70% obstruction in an epicardial vessel with &ge; 2mm diameter or &ge; 50% obstruction in the left main coronary artery. Pts were divided in two groups according to the scheduling of PCI before (&lt; 6 months) or concomitantly with TAVI. Comparison of groups was made using Chi-square, t-test and Mann-Whitney analysis. Primary endpoint was defined as time to all-cause mortality of last follow-up over 5 years after TAVI. Kaplan Meier survival curves were used to estimate the risk of events and Cox regression analysis was used to assess the prognostic relevance of different variables. </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 78 pts (50% male) were included, with a mean age of 83 &plusmn; 5,4 years and a median follow-up of 28 months. 47 pts (60.3%) were submitted to PCI before TAVI and 31 pts (39.7%) were treated concomitantly. There were no differences between the groups regarding number of vessels involved, significant left main disease (p=0,234) or proximal left anterior descending disease (p=0.982). PCI concomitantly with TAVI was associated with higher mean contrast volume (420&plusmn;110 vs 256&plusmn;120 mL, p &lt; 0.001) and longer procedure duration (200&plusmn;58 vs 154&plusmn;51 min, p=0,006) of valve implantation. Regarding laboratory parameters, there was a greater decline in mean haemoglobin levels in the group of PCI concomitantly with TAVI (-2.7 &plusmn; 1.5 vs -2.0 &plusmn; 1.6, p=0.047), but no differences regarding GFR change (p=0,681). There were no statistically significant differences between the groups regarding 30-day MACE (p=0.254). Regarding long term follow-up, pts submitted to periprocedural PCI had statistically significant higher all-cause death at 5 years (log rank p = 0.017) with a HR of 2,5 (95% CI [1.146 &ndash; 5.285], p = 0.021), even after adjusting for clinical variables,&nbsp;with an HR of 3.0 (95% CI [1.198-7.505], p = 0.019).</span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusions: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Concomitant PCI with TAVI was associated with higher all-cause mortality at 5 years than PCI performed before TAVI. Concomitant PCI was also associated with higher mean contrast volume and longer procedure duration of TAVI, and greater decline in mean haemoglobin levels during the hospital stay. No statistically significant differences between the groups were found regarding 30-day MACE.</span></span></p>