Division of Cardiology, Washington Hospital Center, Washington, DC.
Catheter Cardiovasc Interv. 2013 Dec 1;82(7):E835-41. doi: 10.1002/ccd.23193. Epub 2013 Aug 24.
Coronary artery disease often coexists with severe aortic stenosis. The feasibility and safety of combined balloon aortic valvuloplasty (BAV) and percutaneous coronary intervention (PCI) are unknown.
To compare outcomes and complications of combined BAV and PCI with BAV alone.
The study cohort consisted of 409 patients with severe aortic stenosis undergoing BAV from 1/2007 to 12/2010. Overall, 329 patients underwent BAV alone and 80 underwent concomitant PCI. Clinical and hemodynamic data, as well as acute and intermediate-term outcomes, were collected.
At the operator's discretion PCI was done before BAV in 66 (82.5%) and after in 14 (17.5%). Patients who underwent concomitant procedures had a higher incidence of prior stroke and a lower incidence of atrial fibrillation. Procedure time and fluoroscopic time were significantly greater in the BAV/PCI group, (90.0 ± 36.6 vs. 72.8 ± 39.8, P = 0.002 and 20.5 ± 10.9 vs. 12.9 ± 7.0, P < 0.001). Significantly more radiographic contrast was used in the BAV/PCI group (95.1 ± 45.5 vs. 36.7 ± 38.4 cm(3) , P < 0.001. Serious adverse events occurred with equal frequency 13.7 and 17.3%, P = 0.44). Transfusion requirement was also similar (21.2% vs. 20.0%, P = 0.81). The frequency of a periprocedural increase in troponin or creatinine was also similar. In the BAV alone group the mortality rate was 48.6% (n = 160) during a mean follow-up of 191 days, and in the BAV/PCI group the mortality rate was 40% (n = 32) during mean follow-up of 175.5 day, P = 0.34.
Combined BAV and PCI are safe and are associated with similar complications as BAV alone and may offer protection against myocardial ischemia during BAV.
冠心病常与严重主动脉瓣狭窄并存。球囊主动脉瓣成形术（BAV）联合经皮冠状动脉介入治疗（PCI）的可行性和安全性尚不清楚。
比较单纯 BAV 与 BAV 联合 PCI 的治疗效果和并发症。
本研究纳入了 2007 年 1 月至 2010 年 12 月间 409 例接受 BAV 的严重主动脉瓣狭窄患者。其中 329 例患者仅行 BAV，80 例患者行 BAV 联合 PCI。收集了临床和血流动力学数据以及急性和中期结果。
根据术者的判断，66 例（82.5%）患者先进行 PCI 后进行 BAV，14 例（17.5%）患者先进行 BAV 后进行 PCI。行联合治疗的患者既往卒中发生率较高，房颤发生率较低。BAV/PCI 组的手术时间和透视时间显著延长（90.0 ± 36.6 比 72.8 ± 39.8，P = 0.002 和 20.5 ± 10.9 比 12.9 ± 7.0，P < 0.001）。BAV/PCI 组使用的造影剂也显著增加（95.1 ± 45.5 比 36.7 ± 38.4 cm³，P < 0.001）。严重不良事件的发生率相同（13.7%和 17.3%，P = 0.44）。输血需求也相似（21.2%和 20.0%，P = 0.81）。围手术期肌钙蛋白或肌酐升高的发生率也相似。在单纯 BAV 组，160 例患者（48.6%）在平均 191 天的随访期间死亡，而在 BAV/PCI 组，32 例患者（40%）在平均 175.5 天的随访期间死亡，P = 0.34。
BAV 联合 PCI 是安全的，与单纯 BAV 相关的并发症相似，并且可能在 BAV 期间提供对心肌缺血的保护。
