Percutaneous coronary intervention before transcatheter aortic valve implantation: A propensity score matched analysis

• Published in: Cardiovascular revascularization medicine 2024-08, Vol.65, p.10-15
• Main Authors: Khan, Safi U., Dani, Sourbha S., Ganatra, Sarju, Ahmed, Talha, Agalan, Amro, Khadke, Sumanth, Agarwal, Siddharth, Zaid, Syed, Arshad, Hassaan B., Zahid, Salman, Shah, Alpesh R., Goel, Sachin S., Kleiman, Neal S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; All-cause mortality; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Databases, Factual; Female; Humans; Male; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Propensity Score; Retrospective Studies; Risk Assessment; Risk Factors; Stable coronary artery disease; Stroke; Time Factors; Transcatheter aortic valve intervention; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome
• ISSN: 1553-8389; 1878-0938; 1878-0938
• DOI: 10.1016/j.carrev.2024.03.011

The role of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) who subsequently undergo transcatheter aortic valve replacement (TAVR) remains uncertain. Therefore, we conducted this study to assess the association of PCI before TAVR with mortality and cardiovascular outcomes. We used the TriNetX database (Jan 2012 - Aug 2022) and grouped patients into PCI (3 months or less) before TAVR and no PCI. We performed propensity score matched (PSM) analyses for outcomes at 30 days and 1 year. Of 17,120 patients undergoing TAVR, 2322 (14 %) had PCI, and 14,798 (86 %) did not have PCI before TAVR. In the PSM cohort (2026 patients in each group), PCI was not associated with lower all-cause mortality at 30 days (HR: 1.25, 95 % CI: 0.82–1.90) or 1 year (HR: 1.02, 95 % CI: 0.83–1.24). Frequency of repeat PCI after TAVR was low in both no PCI vs. PCI (2.4 % vs. 1.2 %) at 1 year; PCI was associated with a lower rate of repeat PCI (HR: 0.49, 95 % CI: 0.30–0.80). Sensitivity analysis revealed an E-value of 3.5 for repeat PCI (E-value for lower CI for HR: 1.81). PCI was not linked to reductions in MI, heart failure exacerbation, all-cause hospitalization, major bleeding, or permanent pacemaker/implantable cardioverter defibrillator. This analysis showed that PCI prior to TAVR was not associated with improvement in all-cause mortality. However, PCI was associated with a reduced rate of repeat PCI at 1 year. •We examined a large United States (US)-based database to investigate the demographic and clinical profiles of transcatheter aortic valve implantation (TAVI) recipients who underwent percutaneous coronary intervention (PCI) and to determine whether PCI influences mortality and cardiovascular outcomes before TAVI.•PCI did not impact all-cause mortality, myocardial infarction (MI), heart failure (HF) exacerbation, all-cause hospitalization, or major bleeding at 30 days or 1 year in patients with stable coronary artery disease (CAD) than those who did not undergo PCI.•There was a significant reduction in repeat PCI at 1 year, and sensitivity analyses demonstrated that the observed association is robust against potential unmeasured confounding.