Comparison of Staged and Concomitant Percutaneous Coronary Intervention in Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Cohort Study.

AIM: This study aims to compare the clinical outcomes of concomitant versus staged percutaneous coronary intervention (PCI) in patients with severe aortic valve disease and significant coronary artery stenosis undergoing transcatheter aortic valve replacement (TAVR). METHODS: We retrospectively analyzed 180 patients with severe aortic valve disease and significant coronary artery stenosis who underwent TAVR with PCI during the same hospitalization. Patients were treated using either a concomitant strategy (PCI and TAVR performed on the same day) or a staged strategy (procedures performed on different days). Procedural success, valve hemodynamics, and perioperative complications were compared between strategies. RESULTS: Overall procedural success was achieved in 168 of 180 patients (93.3%), without a significant difference between the concomitant and staged groups (92.2% vs. 97.4%, p = 0.467). Transvalvular pressure gradients decreased markedly after TAVR in both groups, from 81.7 (66.3, 99.6) mmHg to 20.0 (12.7, 24.8) mmHg in the concomitant group and from 75.2 (63.2, 97.8) mmHg to 14.9 (8.4, 27.3) mmHg in the staged group (both p < 0.001). Perioperative mortality occurred in 6 (4.3%) patients in the concomitant group and in none of the staged group (p = 0.343). Rates of permanent pacemaker implantation (1.4% vs. 0%), myocardial infarction (0.7% vs. 2.6%), major bleeding (2.1% vs. 0%), stroke (5.0% vs. 0%), and acute kidney injury (13.5% vs. 12.8%) were infrequent in both groups (all p-values > 0.05). CONCLUSIONS: In this cohort, both concomitant and staged PCI strategies achieve high procedural success, and no statistically significant differences in early clinical outcomes are observed between the two strategies. Nevertheless, the definitive optimal timing of PCI remains to be elucidated by future large-scale studies with extended follow-up.