Complete versus incomplete coronary revascularisation in patients undergoing PCI after TAVI.
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Pivato Carlo Andrea, Fontana Nicole, Gramss Leon, Di Angelantonio Emanuele, Ieva Francesca, Godino Cosmo, Nakase Masaaki, Hug Karsten, Rheude Tobias Andreas, Muñoz-García Antonio Jesús, Jimenez Diaz Victor Alfonso, Ielasi Alfonso, Barbanti Marco, Costa Giuliano, Anzuini Angelo, Quadri Giorgio, Lopez-Otero Diego, Garot Philippe, Bucciarelli Loredana, Brouwer Jorn, Reimers Bernhard, Regazzoli Damiano, Testa Luca, Sanz-Sanchez Jorge, Tomii Daijiro, Chieffo Alaide, Joner Michael, Sardella Gennaro, Cerrato Enrico, Nombela-Franco Luis, Condorelli Gianluigi, Pilgrim Thomas, Stefanini Giulio Giuseppe
Аннотация
AIMS: To evaluate the long-term clinical outcomes of CR versus ICR in patients undergoing PCI after TAVI.
METHODS: We analysed 447 patients from the multicentre, international Revascularization After Transcatheter Aortic Valve Implantation (REVIVAL) registry who underwent PCI after TAVI between 2008 and 2023. Patients were classified as CR or ICR according to the presence of residual significant stenosis following PCI. The primary endpoint was the 4-year incidence of major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction or stroke. The Kaplan-Meier method was used to estimate cumulative event rates, and a weighted Cox regression model employing an entropy balance approach was used to adjust for possible confounders.
RESULTS: ICR was achieved in 132 patients (29.5%) and CR in 315 patients (70.5%). The mean follow-up after PCI was 1065±904 days (1213±938 in the ICR group; 1002±883 in the CR group). The crude 4-year incidence of MACE was 35.0% with ICR and 34.7% with CR (HR 0.93, 95% CI 0.62 to 1.39, p=0.710). Adjusted analysis confirmed no significant difference (32.5% vs 34.1%; HR 1.01, 95% CI 0.62 to 1.64, p=0.971).
CONCLUSION: In this registry, CR after TAVI was common but not associated with improved outcomes compared with ICR. These results support a selective rather than systematic pursuit of CR in elderly, high-risk post-TAVI patients.