Timing and Outcomes of PCI in Conjunction With TAVR With Balloon-Expandable Valves.

BACKGROUND: The optimal timing for percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) is debatable.

OBJECTIVES: The aim of this study was to compare outcomes based on the timing of PCI in stable coronary artery disease patients undergoing TAVR.

METHODS: Leveraging the STS/ACC TVT Registry and Medicare Linkage, we analyzed patients with stable coronary artery disease undergoing PCI and TAVR between 2015 and 2023 using the SAPIEN 3 balloon-expandable valve platform. This analysis included patients who underwent PCI within ±90 days of the index TAVR procedure. All-cause mortality, stroke, and a composite of mortality and stroke were analyzed up to 3 years using Medicare Linkage.

RESULTS: Of the 51,480 patients who underwent PCI and TAVR with SAPIEN 3 platforms during the study period, 84.7% had PCI within 90 days before TAVR, 13.9% had concomitant PCI, and 1.4% had PCI within 90 days after TAVR. In the propensity-matched analysis, patients undergoing PCI before TAVR had better outcomes in terms of all cause-mortality (38.1% vs 38.8%; P = 0.013) and a composite of mortality and stroke (42.8% vs 43.5%; P = 0.012) compared with the ones undergoing concomitant PCI at 3-year follow-up. Major vascular complications were higher in patients undergoing concomitant PCI and TAVR (2% vs 1.4%; P = 0.003) CONCLUSIONS: Patients undergoing concomitant PCI and TAVR had higher major vascular complications, and slightly higher composite of all-cause mortality and stroke compared with those who underwent PCI within 90 days before the TAVR procedure.