Surgical vs Transcatheter Treatment in Patients With Coronary Artery Disease and Severe Aortic Stenosis.
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Amat-Santos Ignacio J, García-Gómez Mario, Avanzas Pablo, Jiménez-Diaz Víctor, Alonso-Briales Juan H, de la Torre Hernández José M, Sanz-Sánchez Jorge, Diarte-de Miguel José Antonio, Sánchez-Recalde Ángel, Nombela-Franco Luis, Jiménez-Mazuecos Jesús, Serra Vicenç, Nogales-Asensio Juan Manuel, García-Blas Sergio, Gómez-Menchero Antonio, Del Valle Raquel, Mayor Déniz Carolina, Al Houssaini Walid, Veiga-Fernández Gabriela, Diez-Gil José Luis, Jimeno Sánchez Javier, López Menéndez José, Fernández-Cordón Clara, Gómez-Salvador Itziar, Bustamante-Munguira Juan, Kedhi Elvin, San Román J Alberto
Аннотация
OBJECTIVES: This study sought to compare the outcomes of PCI + TAVR vs CABG + SAVR.
METHODS: This national multicenter retrospective study in Spain involved patients with severe AS and CAD treated between 2018 and 2021. Patients underwent either PCI + TAVR or CABG + SAVR and were compared. The primary endpoint was all-cause mortality and stroke at 1 year. Propensity score analysis was performed to mitigate baseline differences.
RESULTS: Of the 1,342 included patients, 625 (46.6%) underwent PCI + TAVR, and 713 (53.1%) underwent CABG + SAVR. Patients in the percutaneous arm were older (age 81.6 ± 5.8 years vs 72.1 ± 7 years; P < 0.001), had a higher prevalence of chronic kidney disease (40.6% vs 14.9%; P < 0.001), and had higher Society of Thoracic Surgeons risk scores (4.3% [interquartile range (Q1-Q3): 2.8-6.4] vs 2.2% [Q1-Q3: 1.4-3.3]; P < 0.001). Technical success rates were 96% for PCI + TAVR and 98.4% for CABG + SAVR (P = 0.008), with similar periprocedural mortality (0.8% vs 0.7%; P = 0.999). However, the mortality + stroke rate at 30 days was higher in the CABG + SAVR group compared with PCI + TAVR, both in the unmatched (12.2% vs 4.7%; P = 0.005) and matched cohorts (8.8% vs 4.5%; P = 0.002), persisting at the 1-year follow-up.
CONCLUSIONS: Despite a lower baseline risk, CABG + SAVR in patients with severe AS and CAD was associated with a higher rate of death and stroke compared with PCI + TAVR, highlighting the necessity for a large, randomized analysis.