Timing of revascularisation in patients undergoing high-risk percutaneous coronary intervention and Transcatheter aortic valve implantation: insights from the ASCoP registry.

Background

Evidence on the management of complex and high-risk coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still limited. In particular, the optimal timing of percutaneous coronary intervention (PCI) relative to TAVI remains uncertain.

Methods

The ASCop is an observational, multicenter registry that retrospectively enrolled patients with a clinical indication for both TAVI and high-risk PCI. For the purpose of this analysis, patients were divided into three groups according to the PCI timing strategy used: PCI concomitant to TAVI, PCI before TAVI, and PCI after TAVI. The primary endpoint was a composite of all-cause death and first unplanned hospitalisation. The secondary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE). A propensity score methodology with inverse probability of treatment weighting (IPTW) was performed to account for selection bias between the three treatment groups.

Results

Of the 519 patients included in the registry, 156 (30.1%) underwent high-risk PCI during the same TAVI procedure, 333 (64.1%) received PCI before TAVI, while in 30 cases (5.8%) PCI was performed after TAVI. At 1-year follow-up, adopting a strategy of staging PCI after TAVI was associated with a higher incidence of the primary endpoint (HR 2.31, 95%CI:1.24-4.32; p-value = 0.008), while staging PCI before TAVI was associated with a lower incidence of MACCE (HR 0.55, 95%CI:0.35-0.85; p-value = 0.008). Results were consistent after IPTW adjustment.

Conclusions

In this high-risk TAVI cohort, the strategy of staging high-risk PCI after TAVI was associated with an increased risk of adverse events at 1-year.