Stefanini Giulio G, Cerrato Enrico, Pivato Carlo Andrea, Joner Michael, Testa Luca, Rheude Tobias, Pilgrim Thomas, Pavani Marco, Brouwer Jorn, Lopez Otero Diego, Munoz Garcia Erika, Barbanti Marco, Biasco Luigi, Varbella Ferdinando, Reimers Bernhard, Jimenez Diaz Victor Alfonso, Leoncini Massimo, Salido Tahoces Maria Luisa, Ielasi Alfonso, de la Torre Hernandez Jose M, Mylotte Darren, Garot Philippe, Chieffo Alaide, Nombela-Franco Luis
Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy.
Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital, Rivoli, Turin, Italy.
JACC Cardiovasc Interv. 2021 Jan 25;14(2):198-207. doi: 10.1016/j.jcin.2020.10.031.
This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR).
Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated.
Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry.
Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non-ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150).
Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501).
本研究旨在评估经导管主动脉瓣置换术（TAVR）后不同时间段内经皮冠状动脉介入治疗（PCI）的发生率及原因。
冠状动脉疾病（CAD）与主动脉狭窄常并存，但TAVR后CAD的最佳治疗方案仍未完全阐明。
将TAVR后接受非计划PCI的患者纳入一项国际多中心注册研究。
2008年7月至2019年3月，共有133例患者（占15325例总队列的0.9%）在TAVR后接受了非计划PCI（球囊扩张式生物假体后为36.1%，自膨胀式生物假体后为63.9%）。PCI的中位时间为191天（四分位间距：59至480天）。PCI的每日发生率在TAVR后的第一周最高，随后随时间下降。总体而言，大多数患者因急性冠状动脉综合征接受PCI，具体而言，32.3%为非ST段抬高型心肌梗死，15.4%为不稳定型心绞痛，9.8%为ST段抬高型心肌梗死，2.2%为心脏骤停。然而，慢性冠状动脉综合征是2年后的主要适应证。几乎所有病例（96.6%）报告PCI成功，球囊扩张式和自膨胀式生物假体治疗的患者之间无显著差异（100%对94.9%；p = 0.150）。
TAVR后非计划PCI很少见，其发生率在TAVR后随时间下降。PCI的主要适应证在TAVR后的前2年为急性冠状动脉综合征，此后慢性冠状动脉综合征变得普遍。TAVR后非计划PCI通常成功实施，球囊扩张式和自膨胀式生物假体之间无明显差异。（经导管主动脉瓣植入术后血运重建[REVIVAL]；NCT03283501）
