Francesco Tartaglia, Antonio Mangieri, Andrea R Munafò, Damiano Regazzoli, Giuseppe Esposito, Francesco Soriano, Ketina Arslani, Stephanie Brunner, Sarah Verhemel, Andrea Buono, Mattia Squillace, José Luis Díez Gil, Andrea Scotti, Alessandro Mandurino-Mirizzi, David Bauer, Pablo Codner, Kerstin Piayda, Italo Porto, Stefano Nava, Matteo Maurina, Mauro Gitto, Horst Sievert, Ran Kornowski, Petr Toušek, Marco Mussardo, Giulio Stefanini, Azeem Latib, Jorge Sanz Sanchez, Diego Maffeo, Francesco Bedogni, Bernhard Reimers, Nicholas Van Mieghem, Francesco Saia, Stefan Toggweiler, Jacopo A Oreglia, Ole De Backer, Claudio Montalto
In patients undergoing CHIP and TAVI, CR was associated with a reduction in CV hospitalizations. Further studies are needed to confirm this finding.
BACKGROUND: Complex coronary artery disease frequently coexists with severe aortic stenosis. The prognostic impact of complete revascularization (CR) versus incomplete revascularization (IR) in patients undergoing complex and/or high-risk indicated percutaneous coronary intervention (CHIP) and transcatheter aortic valve implantation (TAVI) remains unclear.
METHODS: We analyzed 550 patients who underwent CHIP and transfemoral TAVI between 2013 and 2023 at 14 international centers. Patients were stratified by completeness of revascularization. The primary endpoint was a composite of all-cause death and unplanned cardiovascular (CV) hospitalization at 1 year.
RESULTS: CR was achieved in 299 patients (54.4%). Patients with IR more frequently had three-vessel disease, bifurcation lesions, left main disease, and need for mechanical support. Balloon-expandable valves were more frequently implanted in the CR cohort. Short-term outcomes were similar in the two groups. At 1 year, the incidence of the primary endpoint did not differ significantly between CR and IR groups (20.1 vs. 27.3%, hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.49-1.07). CV rehospitalizations were significantly reduced in the CR group (14.8 vs. 22.8%, HR 0.61, 95% CI 0.38-0.97) even after multivariable adjustment and excluding hospitalizations for repeat revascularization.
CONCLUSIONS: In patients undergoing CHIP and TAVI, CR was associated with a reduction in CV hospitalizations. Further studies are needed to confirm this finding.