Coronary angioplasty or medical treatment in patients with aortic stenosis and coronary artery disease undergoing transcatheter aortic valve implantation: a real world analysis
| Autor: | R Belo Nunes, L M A Da Costa, M J Cantarelli, H Castello Junior, G B F Oliveira, A Avezum Junior |
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| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | European Heart Journal. 43 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehac544.2089 |
| Popis: | Backgroud Patients undergoing transcatheter aortic valve implantation (TAVI) due to severe aortic stenosis have a high prevalence of coronary artery disease (CAD). As many of them have high surgical risk, CAD treatment in this group usually has been carried out with optimal medical treatment alone or associated with percutaneous coronary intervention (PCI). However, the best approach in this scenario is not well established. Purpose We aimed to compare the incidences of major adverse cardiovascular outcomes in patients with aortic stenosis and chronic CAD treated with medical treatment alone or medical treatment plus PCI before or during TAVI, using data from a large multinational electronic health record network (TriNetX). Methods Patients aged ≥18 years with severe aortic stenosis and CAD who underwent TAVI in the last 10 years before the analysis were considered eligible. Patients who underwent PCI before or during TAVI were named the PCI-TAVI group and no coronary intervention patients were named isolated TAVI group. Patients with a past history of acute coronary syndrome, stroke or coronary artery bypass graft before TAVI were excluded from the analysis. The primary outcome was major adverse cardiovascular events (MACE) including the composite of death, unstable angina or myocardial infarction and ischemic stroke. We used propensity score matching to balance the cohorts. The 5-year cumulative incidences for MACE, Kaplan Meier curves and hazard ratios were calculated. Results We identified 13,171 patients undergoing isolated TAVI and 1,884 patients undergoing TAVI and PCI. Using propensity score matching, 1,884 patients in each group were compared. The 5-year incidence of MACE was 23.1% in the isolated TAVI group vs 24.7% in the PCI-TAVI group. The probability of survival without MACE was not significantly different between the isolated TAVI group vs PCI-TAVI group (47.4% vs 50.3%, Log-rank test p=0.718) (Figure 1). The hazard ratio (HR) between the 2 groups was also not significant (HR 1.027, CI 95% 0.89–1.18). Conclusions In a real-world cohort of patients with severe aortic stenosis and chronic coronary artery disease, the 5-year probability of major adverse cardiovascular events was not different between patients undergoing isolated TAVI versus patients undergoing PCI before or during TAVI. Funding Acknowledgement Type of funding sources: None. |
| Databáze: | OpenAIRE |
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