Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease
Por:
Alperi, A, Mohammadi, S, Campelo-Parada, F, Munoz-Garcia, E, Nombela-Franco, L, Faroux, L, Veiga, G, Serra, V, Fischer, Q, Pascual, I, Asmarats, L, Gutierrez, E, Regueiro, A, Vilalta, V, Ribeiro, HB, Matta, A, Munoz-Garcia, A, Armijo, G, Metz, D, Hernandez, JMDT, Rodenas-Alesina, E, Urena, M, Moris, C, Arzamendi, D, Perez-Fuentes, P, Fernandez-Nofrerias, E, Campanha-Borges, DC, Mesnier, J, Voisine, P, Dumont, E, Kalavrouziotis, D, Rodes-Cabau, J
Publicada:
22 nov 2021
Ahead of Print:
1 nov 2021
Resumen:
OBJECTIVES The aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention [PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting [CABG]). BACKGROUND Patients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients. METHODS A multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYN-TAX [Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cere-brovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated. RESULTS A total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7). CONCLUSIONS In patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted. (J Am Coll Cardiol Intv 2021;14:2490-2499) (c) 2021 by the American College of Cardiology Foundation.
Filiaciones:
Alperi, A:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Mohammadi, S:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Campelo-Parada, F:
Rangueil Univ Hosp, Toulouse, France
Munoz-Garcia, E:
Hosp Univ Virgen Victoria, Malaga, Spain
Nombela-Franco, L:
Hosp Clin San Carlos, Cardiovasc Inst, IdISSC, Madrid, Spain
Faroux, L:
Reims Univ Hosp, Reims, France
Veiga, G:
Hosp Marques Valdecilla, Santander, Spain
Serra, V:
Hosp Univ Vall dHebron, Barcelona, Spain
Fischer, Q:
Hop Xavier Bichat, AP HP, Paris, France
Pascual, I:
Hosp Univ Cent Asturias, Oviedo, Spain
Asmarats, L:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Gutierrez, E:
Hosp Gregorio Maranon, Madrid, Spain
Regueiro, A:
Hosp Clin Barcelona, Barcelona, Spain
Vilalta, V:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Ribeiro, HB:
Univ Sao Paulo, Heart Inst, Inst Coracao InCor, Sao Paulo, Brazil
Matta, A:
Rangueil Univ Hosp, Toulouse, France
Munoz-Garcia, A:
Hosp Univ Virgen Victoria, Malaga, Spain
Armijo, G:
Hosp Clin San Carlos, Cardiovasc Inst, IdISSC, Madrid, Spain
Hernandez, JMDT:
Hosp Marques Valdecilla, Santander, Spain
Rodenas-Alesina, E:
Hosp Univ Vall dHebron, Barcelona, Spain
Urena, M:
Hop Xavier Bichat, AP HP, Paris, France
Moris, C:
Hosp Univ Cent Asturias, Oviedo, Spain
Arzamendi, D:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Perez-Fuentes, P:
Hosp Clin Barcelona, Barcelona, Spain
Fernandez-Nofrerias, E:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Campanha-Borges, DC:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Mesnier, J:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Voisine, P:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Dumont, E:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Kalavrouziotis, D:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Rodes-Cabau, J:
Laval Univ, Quebec Heart & Lung Inst, 2725 Chemin Ste Foy, Quebec City, PQ G1V 4G5, Canada
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
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