Clinical impact of complex percutaneous coronary intervention in the pre-TAVR workup

Marisa Avvedimento; Francisco Campelo-Parada; Luis Nombela-Franco; Quentin Fischer; Pierre Donaint; Vicenç Serra; Gabriela Veiga; Enrique Gutiérrez; Anna Franzone; Victoria Vilalta; Alberto Alperi; Ander Regueiro; Lluis Asmarats; Henrique B Ribeiro; Anthony Matta; Antonio Muñoz-García; Gabriela Tirado; Marina Urena; Damien Metz; Eduard Rodenas-Alesina; Jose María de la Torre Hernández; Domenico Angellotti; Eduard Fernández-Nofrerías; Isaac Pascual; Pablo Vidal-Calés; Dabit Arzamendi; Diego Carter Campanha-Borges; Kim Hoang Trinh; Jorge Nuche; Mélanie Côté; Laurent Faroux; Josep Rodés-Cabau

doi:10.1016/j.rec.2024.05.002

Clinical impact of complex percutaneous coronary intervention in the pre-TAVR workup

Rev Esp Cardiol (Engl Ed). 2024 May 17:S1885-5857(24)00159-2. doi: 10.1016/j.rec.2024.05.002. Online ahead of print.

[Article in English, Spanish]

Authors

Marisa Avvedimento¹, Francisco Campelo-Parada², Luis Nombela-Franco³, Quentin Fischer⁴, Pierre Donaint⁵, Vicenç Serra⁶, Gabriela Veiga⁷, Enrique Gutiérrez⁸, Anna Franzone⁹, Victoria Vilalta¹⁰, Alberto Alperi¹¹, Ander Regueiro¹², Lluis Asmarats¹³, Henrique B Ribeiro¹⁴, Anthony Matta², Antonio Muñoz-García¹⁵, Gabriela Tirado³, Marina Urena⁴, Damien Metz⁵, Eduard Rodenas-Alesina⁶, Jose María de la Torre Hernández⁷, Domenico Angellotti⁹, Eduard Fernández-Nofrerías¹⁰, Isaac Pascual¹¹, Pablo Vidal-Calés¹², Dabit Arzamendi¹³, Diego Carter Campanha-Borges¹⁴, Kim Hoang Trinh¹, Jorge Nuche¹, Mélanie Côté¹, Laurent Faroux⁵, Josep Rodés-Cabau¹⁶

Affiliations

¹ Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
² Cardiology Department, Hôpital Universitaire de Toulouse, Toulouse, France.
³ Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
⁴ Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁵ Cardiology Department, Reims University Hospital, Reims, France.
⁶ Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁷ Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain.
⁸ Servicio de Cardiología, Hospital Gregorio Marañón, Madrid, Spain.
⁹ Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
¹⁰ Servicio de Cardiología, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
¹¹ Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
¹² Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
¹³ Servicio de Cardiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
¹⁴ Cardiology Department, Heart Institute, University of São Paulo, São Paulo, Brazil.
¹⁵ Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
¹⁶ Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. Electronic address: [email protected].

PMID: 38763211
DOI: 10.1016/j.rec.2024.05.002

Abstract

Introduction and objectives: In patients undergoing percutaneous coronary intervention (PCI) in the workup pre-transcatheter aortic valve replacement (TAVR), the clinical impact of coronary revascularization complexity remains unknown. This study sought to examine the impact of PCI complexity on clinical outcomes after TAVR in patients undergoing PCI in the preprocedural workup.

Methods: This was a multicenter study including consecutive patients scheduled for TAVR with concomitant significant coronary artery disease. Complex PCI was defined as having at least 1 of the following features: 3 vessels treated, ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with 2 stents implanted, total stent length >60mm, or chronic total occlusion. The rates of major adverse cardiac events (MACE), including cardiovascular mortality, myocardial infarction, and coronary revascularization were evaluated.

Results: A total of 1550 patients were included, of which 454 (29.3%) underwent complex PCI in the pre-TAVR workup. After a median follow-up period of 2 [1-3] years after TAVR, the incidence of MACE was 9.6 events per 100 patients-years. Complex PCI significantly increased the risk of cardiac death (HR, 1.44; 95%CI, 1.01-2.07), nonperiprocedural myocardial infarction (HR, 1.52; 95%CI, 1.04-2.21), and coronary revascularization (HR, 2.46; 95%CI, 1.44-4.20). In addition, PCI complexity was identified as an independent predictor of MACE after TAVR (HR, 1.31; 95%CI, 1.01-1.71; P=.042).

Conclusions: In TAVR candidates with significant coronary artery disease requiring percutaneous treatment, complex revascularization was associated with a higher risk of MACE. The degree of procedural complexity should be considered a strong determinant of prognosis in the PCI-TAVR population.

Keywords: Complex PCI; ICP; ICP compleja; Implante percutáneo de válvula aórtica; Intervención coronaria percutánea; PCI; Percutaneous coronary intervention; TAVI; TAVR; Transcatheter aortic valve replacement.