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. 2023 Sep 18;19(7):589-599.
doi: 10.4244/EIJ-D-23-00186.

Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation

Tobias Rheude  1 , Giuliano Costa  2 , Flavio Luciano Ribichini  3 , Thomas Pilgrim  4 , Ignacio J Amat Santos  5 , Ole De Backer  6 , Won-Keun Kim  7 , Henrique Barbosa Ribeiro  8 , Francesco Saia  9 , Matjaz Bunc  10 , Didier Tchétché  11 , Philippe Garot  12 , Darren Mylotte  13 , Francesco Burzotta  14 , Yusuke Watanabe  15 , Francesco Bedogni  16 , Tullio Tesorio  16 , Marco Tocci  17 , Anna Franzone  18 , Roberto Valvo  19 , Mikko Savontaus  20 , Hendrik Wienemann  21 , Italo Porto  22 , Caterina Gandolfo  23 , Alessandro Iadanza  24 , Alessandro S Bortone  25 , Markus Mach  26 , Azeem Latib  27 , Luigi Biasco  28 , Maurizio Taramasso  29 , Marco Zimarino  30 , Daijiro Tomii  4 , Philippe Nuyens  6 , Lars Sondergaard  31 , Sergio F Camara  8 , Tullio Palmerini  9 , Mateusz Orzalkiewicz  9 , Klemen Steblovnik  10 , Bastien Degrelle  11 , Alexandre Gautier  12 , Paolo Alberto Del Sole  3 , Andrea Mainardi  3 , Michele Pighi  3 , Mattia Lunardi  3   13 , Hideyuki Kawashima  15 , Enrico Criscione  16 , Vincenzo Cesario  32 , Fausto Biancari  33 , Federico Zanin  33 , Giovanni Esposito  18 , Matti Adam  21 , Eberhard Grube  21 , Stephan Baldus  21 , Vincenzo De Marzo  22 , Elisa Piredda  22 , Stefano Cannata  23 , Fortunato Iacovelli  25 , Martin Andreas  26 , Valentina Frittitta  19 , Elena Dipietro  19 , Claudia Reddavid  19 , Orazio Strazzieri  19 , Silvia Motta  19 , Domenico Angellotti  18 , Carmelo Sgroi  2 , Erion Xhepa  1 , Faraj Kargoli  27 , Corrado Tamburino  2 , Michael Joner  1 , Marco Barbanti  2   34
Affiliations

Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation

Tobias Rheude et al. EuroIntervention. .

Abstract

Background: The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown.

Aims: We sought to compare different PCI timing strategies in TAVI patients.

Methods: The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method.

Results: A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days.

Conclusions: In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.

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Conflict of interest statement

T. Rheude received speaker fees from AstraZeneca and SIS Medical. F.L. Ribichini is aproctor for Edwards Lifesciences and Medtronic. T. Pilgrim received research grants to the institution from Biotronik, Boston Scientific, and Edwards Lifesciences; andspeakers/consultancy fees from Medtronic, Boston Scientific, Biotronik, Abbott, and HighLife SAS. O. De Backer received institutional research grants and/or consulting fees from Abbott and Boston Scientific. W-K. Kim received personal fees from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, Meril Life Sciences, and Shockwave Medical. I.J. Amat-Santos is aproctor for Medtronic, Boston Scientific, and Meril Life Sciences. P. Garot received speaker/consultant fees from Abbott, Biosensors, Boston Scientific, Edwards Lifesciences, GE HealthCare, and Terumo. He serves as amedical director and is ashareholder of CERC (Cardiovascular European Research Center), aCRO based in Massy, France. M. Savontaus is aconsultant for Medtronic and Boston Scientific. C. Gandolfo is aproctor for Edwards Lifesciences. L. Sondergaard is Chief Medical Officer and Divisional VP for Medical Affairs at Abbott Structural Heart; and has received consultant fees and/or institutional research grants from Abbott, Boston Scientific, Medtronic, and SMT. M. Taramasso reports consultant or consultancy fees from Abbott Vascular, Edwards Lifesciences, Medtronic, Boston Scientific, Shenqi Medical, MEDIRA, ReCross, Hi-D Imaging, VentraMed, CoreMedic, Simulands, and CardioValve. M. Adam reports personal fees/speaker honoraria from Abbott, Boston Scientific, Edwards Lifesciences, JenaValve, and Medtronic. S. Baldus reports lecture fees from JenaValve and lecture and speaker fees from Edwards Lifesciences. M. Andreas is a proctor/consultant/speaker for Edwards Lifesciences, Abbott, Medtronic, Boston Scientific, Zoll, and AbbVie; and received institutional research grants from Edwards Lifesciences, Abbott, Medtronic, and LSI. C. Tamburino is aconsultant for Medtronic. M. Joner reports institutional grant support from Boston Scientific, Cardiac Dimensions, Edwards Lifesciences, and Infraredx; consulting fees from Biotronik, TRiCares, Veryan, and Shockwave; speaker fees from Abbott, AstraZeneca, Biotronik, Boston Scientific, Cardiac Dimensions, Edwards Lifesciences, ReCor Medical, and Shockwave Medical; participation on asteering committee at Biotronik and Edwards Lifesciences; and travel support from Boston Scientific, Cardiac Dimensions, Edwards Lifesciences, and SIS Medical. M. Barbanti is aconsultant for Boston Scientific, Edwards Lifesciences, and Medtronic. The other authors have no conflicts of interest to declare. The Guest Editor is amember of the Data and Safety Monitoring Board for astudy by Venus MedTech and receives speaker honoraria (modest) from Edwards Lifesciences.

Figures

Central illustration
Central illustration. Outcomes of patients undergoing transcatheter aortic valve implantation and percutaneous coronary intervention for stable coronary artery disease from the international, multicentre REVASC-TAVI registry.
CAD: coronary artery disease; HF: heart failure; MI: myocardial infarction; PCI: percutaneous coronary intervention; TAVI: transcatheter aortic valve implantation
Figure 1
Figure 1. All-cause death according to PCI timing strategy in patients undergoing TAVI.
A) Time-to-event curves for all-cause death using the Kaplan-Meier method with inverse probability treatment weighting (IPTW) adjustment and B) landmark analysis for all-cause death from 0-30 days (vertical dotted line) and 31-720 days. PCI: percutaneous coronary intervention; TAVI: transcatheter aortic valve implantation
Figure 2
Figure 2. Composite endpoint according to PCI timing strategy in patients undergoing TAVI.
A) Time-to-event curves for the combined endpoint using the Kaplan-Meier method with inverse probability treatment weighting (IPTW) adjustment and B) landmark analysis for the combined endpoint from 0-30 days (vertical dotted line) and 31-720 days. HF: heart failure; MI: myocardial infarction; PCI: percutaneous coronary intervention; TAVI: transcatheter aortic valve implantation
See this image and copyright information in PMC

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