Abstract 14229: Northern New England’S Multicenter Experience With Percutaneous Coronary Intervention Among Patients With Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A14229
• Main Authors: Shah, Jay, Kvasic, Jessica, Frey, Paul, Butzel, David, Robich, Michael P, Quinn, Reed, Jayne, John, Malenka, David J, Vasaiwala, Samip
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19.11.2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.14229

Introduction and BackgroundThe incidence of coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) averages nearly 70%. According to current guidelines, coronary artery bypass grafting (CABG) should be performed concurrently at the time of surgical AVR, however this combined procedure has been associated with worse postoperative outcomes. Another recent option being utilized is percutaneous coronary intervention (PCI) prior to TAVR. In our multi-centered study, we evaluated outcomes in patients who had PCI within the 60 days prior to TAVR.Methods and ResultsIn a retrospective fashion, data of patients undergoing TAVR between 2015 and 2018, who also had coronary artery disease (CAD), was collected from the Northern New England Cardiovascular Disease Study Group (NNE). The NNE, is a voluntary and multidisciplinary group, including 6 medical centers across Maine, New Hampshire and Vermont, developed to share information concerning the treatment of cardiovascular diseases. Three hundred and twelve patients (32.7%) underwent PCI out of the 954 patients with commitment CAD and severe aortic valve stenosis undergoing TAVR. There were no differences in in-hospital mortality, 30-day mortality, stroke rate, or acute kidney injury among patients with CAD prior to TAVR regardless of percutaneous revascularization. 40.9% of the patients had left main and/or left anterior descending artery interventions. Amongst the TAVR and CAD patients who underwent PCI, we noted higher rates of pacer/ICD placement (9.6% vs 5.3% p = 0.012) regardless of prior CABG history.ConclusionsOur observational analysis demonstrates that there are no adverse 30-day mortality outcomes with regards to revascularization amongst patients with CAD undergoing TAVR. However, we did notice a higher rate of Cardiovascular Implantable Electronic Device (CIED) placement in patients undergoing PCI. Randomized clinical trials are needed to further explore the burden of coronary artery disease, incomplete or complete revascularization and clinical outcomes.