Ochiai Tomoki, Yoon Sung-Han, Flint Nir, Sharma Rahul, Chakravarty Tarun, Kaewkes Danon, Patel Vivek, Nakamura Mamoo, Cheng Wen, Makkar Raj
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Am J Cardiol. 2020 May 1;125(9):1361-1368. doi: 10.1016/j.amjcard.2020.01.043. Epub 2020 Feb 8.
Limited data exist regarding the timing of percutaneous coronary intervention (PCI) in patients with coronary artery disease who underwent transcatheter aortic valve implantation (TAVI). We aimed to investigate clinical outcomes of patients who underwent TAVI and planned PCI according to the timing of PCI in relation to the TAVI. Consecutive patients with severe aortic stenosis who underwent TAVI with planned PCI between January 2013 and November 2017 were included. Patients were divided according to the timing of PCI. The primary end point was major adverse cardiac and cerebrovascular events, defined as a composite of all-cause death, myocardial infarction, unplanned revascularization, and stroke. Among 1,756 patients who underwent TAVI, 258 patients underwent planned PCI either before TAVI (n = 143, 55.4%), concomitantly with TAVI (n = 77, 29.8%), or after TAVI (n = 38, 14.7%). All patients in the post-TAVI PCI group were treated using balloon-expandable valves, and neither hemodynamic instability during TAVI nor PCI-related complications were observed. In a multivariable analysis, the timing of PCI was not associated with 2-year major adverse cardiac and cerebrovascular events rate (concomitant vs pre-TAVI, hazard ratio [HR]: 0.92; 95% confidence interval [CI]: 0.52 to 1.66; p = 0.79; post- vs pre-TAVI, HR: 0.45; 95% CI: 0.18 to 1.16; p = 0.10). In conclusion, there were no significant differences in terms of mid-term outcomes among pre-TAVI, concomitant, and post-TAVI PCI groups when the timing of PCI was carefully selected by heart team.
关于接受经导管主动脉瓣植入术（TAVI）的冠状动脉疾病患者进行经皮冠状动脉介入治疗（PCI）的时机，现有数据有限。我们旨在根据PCI与TAVI的时间关系，研究接受TAVI并计划进行PCI的患者的临床结局。纳入2013年1月至2017年11月期间连续接受TAVI并计划进行PCI的重度主动脉瓣狭窄患者。根据PCI的时间对患者进行分组。主要终点是主要不良心脑血管事件，定义为全因死亡、心肌梗死、非计划血管重建和中风的综合。在1756例接受TAVI的患者中，258例患者在TAVI之前（n = 143，55.4%）、与TAVI同时（n = 77，29.8%）或TAVI之后（n = 38，14.7%）接受了计划的PCI。TAVI后PCI组的所有患者均使用球囊扩张瓣膜进行治疗，未观察到TAVI期间的血流动力学不稳定或PCI相关并发症。在多变量分析中，PCI的时机与2年主要不良心脑血管事件发生率无关（同时进行与TAVI前，风险比[HR]：0.92；95%置信区间[CI]：0.52至1.66；p = 0.79；TAVI后与TAVI前，HR：0.45；95%CI：0.18至1.16；p = 0.10）。总之，当心脏团队仔细选择PCI时机时，TAVI前、同时进行和TAVI后PCI组的中期结局无显著差异。
