TAVR/PCI bests SAVR/CABG when treating severe AS and complex CAD
When treating patients with severe aortic stenosis (AS) and complex coronary artery disease (CAD), the combination of transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) is associated with better one-year outcomes than surgical aortic valve replacement (SAVR) and coronary artery bypass graft (CABG) surgery. That was the primary takeaway from a new analysis published in The Lancet.[1]
“Considering the increased risk of adverse events with combined surgical SAVR plus CABG, a percutaneous approach for combined AS and complex CAD becomes appealing,” wrote first author Elvin Kedhi, PhD, MD, with Royal Victoria Hospital in Montreal, Quebec, and colleagues.
Kedhi et al. explored data from 172 patients who underwent treatment from 2018 to 2023. Patients were treated in one of 18 facilities located in the Netherlands, Spain, France, Poland, Austria, Czech Republic, Germany, Greece, Portugal or Slovakia. All patients were at least 70 years old and presented with both symptomatic severe AS and concomitant multivessel or complex CAD.
While 91 patients underwent PCI and TAVR, the other 81 patients underwent SAVR and CABG. All TAVR procedures were performed using Medtronic valves. A significant majority (82%) of PCI patients were treated with fractional flow reserve (FFR)-guided PCI. If TAVR and PCI were not performed simultaneously, TAVR was at least performed within 40 days of index PCI.
Overall, the study’s primary one-year endpoint—a composite of all-cause mortality, myocardial infarction, disabling stroke, unscheduled clinically driven target vessel revascularization, valve reintervention and life-threatening or disabling bleeding events—was seen in 4% of TAVR/PCI patients and 17% of SAVR/CABG patients. This was a significant enough difference, researchers wrote, that it confirmed percutaneous treatment was “superior” to a more surgical approach.
The main driver of this difference was all-cause mortality; no patients died in the TAVR/PCI group, but 10% of patients died in the SAVR/CABG group. TAVR/PCI was also linked to a lower rate of adverse cardiac events, fewer life-threatening or disabling bleeding events and shorter hospitalizations, though the permanent pacemakers rate were higher. There was not a significant difference in the rate of major vascular complications between the two groups.
“The event rate in the FFR-guided PCI plus TAVR group was low, which could reflect improved outcomes over time in patients undergoing PCI plus TAVR,” the authors wrote. “As TAVI has become a routine procedure in catheterization laboratories in Europe, and as the risk of patients treated with TAVR has diminished, the clinical outcomes of TAVR have drastically improved.”
While the group did emphasize that additional research is still necessary, it also shared its hope that these findings could “serve as a valuable reference” for care teams going forward.
Click here to read the full study in The Lancet.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.