Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany.
Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany.
Catheter Cardiovasc Interv. 2024 Jan;103(1):186-193. doi: 10.1002/ccd.30927. Epub 2023 Dec 22.
Patients undergoing transcatheter aortic valve implantation (TAVI) frequently have coronary artery disease requiring percutaneous coronary intervention (PCI). Usually, PCI and TAVI are performed in two separate procedures and current studies are investigating potential benefits regarding the order. However, the two interventions may also be performed simultaneously, thereby limiting the risk associated with repeated vascular access. Data evaluating benefit and harm of concomitant procedures are scarce.
Therefore, this study aimed to evaluate concomitant PCI (coPCI) in TAVI patients regarding Valve Academic Research Consortium 3 (VARC-3) endpoints and long-term mortality.
A total of 2233 consecutive TAVI patients from the EVERY-VALVE registry were analyzed according to the VARC-3 endpoint definitions. A total of 274 patients had undergone TAVI and concomitant PCI (coPCI group). They were compared to 226 TAVI patients who had received PCI within 60 days before TAVI in a stepwise approach (swPCI group) and to the remaining 1733 TAVI patients who had not undergone PCI recently (noPCI group).
Overall median age was 81.4 years, median Society of Thoracic Surgeons score was 4.0%. Patients in the coPCI and in the swPCI group were predominantly male with reduced left-ventricular ejection fraction. Rates of VARC-3 composite endpoints technical success and 30-day device success were comparable between all three groups. Mortality rates at 3 years after TAVI were similar (coPCI, 34.2% vs. swPCI, 31.9% vs. noPCI, 34.0% p = 0.84).
coPCI during TAVI seems comparable in a retrospective analysis. Compared to a stepwise approach, it has similar rates of composite endpoints technical success and device success as well as long-term mortality.
接受经导管主动脉瓣置换术（TAVI）的患者常患有需要经皮冠状动脉介入治疗（PCI）的冠状动脉疾病。通常，PCI 和 TAVI 分两步进行，目前的研究正在探讨这两种顺序的潜在益处。然而，这两种介入也可以同时进行，从而限制了与重复血管入路相关的风险。评估同时进行的益处和危害的数据很少。
因此，本研究旨在评估 TAVI 患者同时进行 PCI（coPCI）的 Valve Academic Research Consortium 3（VARC-3）终点和长期死亡率。
根据 VARC-3 终点定义，对 EVERY-VALVE 注册的 2233 例连续 TAVI 患者进行了分析。共有 274 例患者接受了 TAVI 和同时进行的 PCI（coPCI 组）。他们与在 TAVI 前 60 天内接受过 PCI 的 226 例 TAVI 患者（逐步 PCI 组）和未接受过近期 PCI 的其余 1733 例 TAVI 患者（无 PCI 组）进行了比较。
总体中位年龄为 81.4 岁，中位胸外科医生协会评分 4.0%。coPCI 组和 swPCI 组患者主要为男性，左心室射血分数降低。三组患者的 VARC-3 复合终点技术成功率和 30 天器械成功率相似。TAVI 后 3 年死亡率相似（coPCI 组，34.2%；swPCI 组，31.9%；无 PCI 组，34.0%；p=0.84）。
在回顾性分析中，TAVI 期间的 coPCI 似乎是可以接受的。与逐步方法相比，它具有相似的复合终点技术成功率和器械成功率以及长期死亡率。
