PCI before TAVR may still be safest strategy for some heart patients
When heart patients with coronary artery disease (CAD) require transcatheter aortic valve replacement (TAVR), care teams should pay close attention to the complexity of that CAD before deciding whether or not to defer percutaneous coronary intervention (PCI) until later. That is according to new data published in JACC: Cardiovascular Interventions.[1]
The recent PRO-TAVI trial, published in The Lancet in March, found deferring PCI is generally a safe strategy when patients undergoing TAVR present with concomitant CAD.[2] However, it was still unclear how the severity of a patient’s CAD should influence these decisions. To learn more, researchers performed a new subanalysis of PRO-TAVI that focuses on the SYNTAX scores of individual patients.
The group reviewed data from 466 patients with significant CAD who underwent TAVR. Each patient was randomized to either undergo PCI before TAVR, or to only undergo TAVR and leave PCI to be performed at a later date. Researchers then calculated the SYNTAX score, a grading tool that assesses CAD severity, for each patient.
Overall, the study’s primary outcome—a composite of all-cause mortality, myocardial infarction, stroke and major bleeding after one year—was not significantly different across any SYNTAX score categories. Patients with deferred PCI were consistently linked to a lower risk of one-year bleeding events.
However, in patients with the highest SYNTAX scores—which means those with the most complex CAD—a composite outcome of all-cause mortality, myocardial infarction and stroke occurred in 30.9% of patients with deferred PCI and 14.8% of patients who underwent PCI right away. This suggests that patients with more severe CAD may benefit from undergoing both procedures instead of waiting to undergo PCI.
“These findings suggest that the extent of CAD should be incorporated into decision-making for TAVR patients with concomitant coronary disease, but confirmation from randomized studies is needed,” wrote first author Gijs M. Broeze, a researcher with Amsterdam University Medical Centers, and colleagues.
Click here to read the full study in JACC: Cardiovascular Interventions, an American College of Cardiology journal.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.