Procedural Characteristics and Late Outcomes of Percutaneous Coronary Intervention in the Workup Pre-TAVR
Por:
Faroux, L, Campelo-Parada, F, Munoz-Garcia, E, Nombela-Franco, L, Fischer, Q, Donaint, P, Serra, V, Veiga, G, Gutierrez, E, Vilalta, V, Alperi, A, Regueiro, A, Asmarats, L, Ribeiro, HB, Matta, A, Munoz-Garcia, A, Armijo, G, Urena, M, Metz, D, Rodenas-Alesina, E, Hernandez, JMD, Fernandez-Nofrerias, E, Pascual, I, Perez-Fuentes, P, Arzamendi, D, Campanha-Borges, DC, del Val, D, Couture, T, Rodes-Cabau, J
Publicada:
23 nov 2020
Resumen:
OBJECTIVES This study sought to determine, in patients undergoing percutaneous coronary intervention (PCI) during the work-up pre-transcatheter aortic valve replacement (TAVR): 1) the clinical and peri-procedural PCI characteristics; 2) the long-term outcomes; and 3) the clinical events in those patients with complex coronary features.
BACKGROUND A PCI is performed in about 25% of TAVR candidates, but procedural features and late outcomes of pre-TAVR PCI remain largely unknown.
METHODS Multicenter study including 1197 consecutive patients who had PCI in the work-up pre-TAVR. A total of 1,705 lesions (1.5 +/- 0.7 lesions per patient) were included. Death, stroke, myocardial infarction, and major adverse cardiovascular and cerebrovascular events (MACCE) were recorded, as well as target lesion failure (TLF) and target vessel failure (TVF).
RESULTS One-half of patients exhibited a multivessel disease and the mean SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) score was 12.1 +/- 9.1. The lesions were of B2/C type, calcified, bifurcation, and ostial in 49.9%, 45.8%, 21.4%, and 19.3% of cases, respectively. After a median follow-up of 2 (interquartile range: 1 to 3) years, a total of 444 (37.1%) patients presented an MACCE. Forty patients exhibited TVF (3.3%), with TLF identified in 32 (2.7%) patients. By multivariable analysis, previous peripheral artery disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.002), atrial fibrillation (p = 0.003), diabetes mellitus (p = 0.012), and incomplete revascularization (p = 0.014) determined an increased risk of MACCE. In patients with unprotected left main or SYNTAX score >32 (n = 128), TLF, TVF, and MACCE rates were 3.9%, 6.3%, and 35.9%, respectively (p = 0.378; p = 0.065, and p = 0.847, respectively, vs. the rest of the population).
CONCLUSIONS Patients undergoing PCI in the work-up pre-TAVR frequently exhibited complex coronary lesions and multivessel disease. PCI was successful in most cases, and TLF and TVF rates at 2-year follow-up were low, also among patients with high-risk coronary features. However, overall MACCE occurred in about one-third of patients, with incomplete revascularization determining an increased risk. These results should inform future studies to better determine the optimal revascularization strategy pre-TAVR. (C) 2020 by the American College of Cardiology Foundation.
Filiaciones:
Faroux, L:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin St Foy, Quebec City, PQ G1V 4G5, Canada
Campelo-Parada, F:
Hop Univ Toulouse, Cardiol Dept, Toulouse, France
Munoz-Garcia, E:
Hosp Univ Virgen de la Victoria, Cardiol Dept, Malaga, Spain
Nombela-Franco, L:
Hosp Clin San Carlos, Inst Cardiovasc, Cardiol Dept, IdISSC, Madrid, Spain
Fischer, Q:
Bichat Claude Bernard Hosp, AP HP, Cardiol Dept, Paris, France
Donaint, P:
Reims Univ Hosp, Cardiol Dept, Reims, France
Serra, V:
Hosp Univ Vall dHebron, Cardiol Dept, Barcelona, Spain
Veiga, G:
Hosp Marques de Valdecilla, Cardiol Dept, Santander, Spain
Gutierrez, E:
Hosp Gregorio Maranon, Cardiol Dept, Madrid, Spain
Vilalta, V:
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Alperi, A:
Hosp Univ Cent Asturias, Cardiol Dept, Oviedo, Spain
Regueiro, A:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Inst Clin Cardiovasc, Hosp Clin, Cardiol Dept, Barcelona, Spain
Asmarats, L:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Barcelona, Spain
Ribeiro, HB:
Univ Sao Paulo, Heart Inst, Cardiol Dept, Sao Paulo, Brazil
Matta, A:
Hop Univ Toulouse, Cardiol Dept, Toulouse, France
Munoz-Garcia, A:
Hosp Univ Virgen de la Victoria, Cardiol Dept, Malaga, Spain
Armijo, G:
Hosp Clin San Carlos, Inst Cardiovasc, Cardiol Dept, IdISSC, Madrid, Spain
Urena, M:
Bichat Claude Bernard Hosp, AP HP, Cardiol Dept, Paris, France
Metz, D:
Reims Univ Hosp, Cardiol Dept, Reims, France
Rodenas-Alesina, E:
Hosp Univ Vall dHebron, Cardiol Dept, Barcelona, Spain
Hernandez, JMD:
Hosp Marques de Valdecilla, Cardiol Dept, Santander, Spain
Fernandez-Nofrerias, E:
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Pascual, I:
Hosp Univ Cent Asturias, Cardiol Dept, Oviedo, Spain
Perez-Fuentes, P:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Inst Clin Cardiovasc, Hosp Clin, Cardiol Dept, Barcelona, Spain
Arzamendi, D:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Barcelona, Spain
Campanha-Borges, DC:
Univ Sao Paulo, Heart Inst, Cardiol Dept, Sao Paulo, Brazil
del Val, D:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin St Foy, Quebec City, PQ G1V 4G5, Canada
Couture, T:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin St Foy, Quebec City, PQ G1V 4G5, Canada
Rodes-Cabau, J:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin St Foy, Quebec City, PQ G1V 4G5, Canada
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