| Institution: | 1. Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy;2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy;3. Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli, Turin, Italy;4. German Heart Center, Munich, Germany;5. IRCSS Policlinico San Donato, Milan, Italy;6. Bern University Hospital, Bern, Switzerland;7. Mauriziano Hospital, Turin, Italy;8. St. Antonius Hospital, Nieuwegein, the Netherlands;9. Santiago Hospital, Santiago, Spain;10. H.C.U. Virgen de la Victoria, Malaga, Spain;11. AOU Policlinico “G. Rodolico - San Marco”, Catania, Italy;12. Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland;13. Hospital Álvaro Cunqueiro, Vigo, Spain;14. SSD Cardiologia Interventistica Ospedale di Sanremo, Sanremo, Italy;15. Ramón y Cajal Hospital, Madrid, Spain;p. Sant’Ambrogio Clinical Institute, Milan, Italy;q. Seriate Hospital, Bergamo, Italy;r. Hospital Universitario Marques de Valdecilla, Instituto e Investigación Sanitaria Valdecilla, Santander, Spain;s. Galway University, Galway, Ireland;t. Hopital Privé Jacques Cartier, Institut Cardiovasculaire Paris-Sud, Ramsay-Santé, Massy, France;u. IRCCS San Raffaele Hospital, Milan, Italy;v. Hospital Clínico Universitario San Carlos, Madrid, Spain |
| Abstract: | ObjectivesThis study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR).BackgroundCoronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated.MethodsPatients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry.ResultsBetween July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non–ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150).ConclusionsUnplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation REVIVAL]; NCT03283501) |
