Complete coronary revascularization during PCI after TAVI did not reduce the 4-year risk of major adverse events compared to incomplete revascularization (adjusted HR 1.01, 95% CI 0.62-1.64).
Does complete revascularization improve long-term clinical outcomes compared to incomplete revascularization in patients undergoing PCI after TAVI?
Complete revascularization during PCI after TAVI does not significantly improve long-term clinical outcomes compared to incomplete revascularization, supporting a selective rather than systematic approach in this high-risk population.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background/Introduction The optimal revascularization strategy for patients undergoing percutaneous coronary intervention (PCI) after transcatheter aortic valve implantation (TAVI) remains undefined. In particular, the prognostic impact of complete (CR) versus incomplete revascularization (ICR) in this setting is unknown. Purpose To evaluate the long-term clinical outcomes of CR versus ICR in patients undergoing PCI after TAVI. Methods We analyzed 447 patients from the multicenter, international REVIVAL-PCI 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 events (MACE), a composite of cardiovascular-death, myocardial infarction, or stroke. The Kaplan-Meier method was used to estimate cumulative event rates, and weighted Cox regression models employing an entropy balance approach were to adjust for clinical and procedural features. Results CR was achieved in 315 patients (70.5%) and ICR in 132 patients (29.5%). 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 0.62–1.39, p=0.71). Adjusted analysis confirmed no difference (32.5% vs. 34.1%; HR 1.01, 95% CI 0.62–1.64, p=0.97). 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.Study population and main findingFor image description, please refer to the figure legend and surrounding text.
Pivato et al. (Sun,) reported a other. Complete coronary revascularization during PCI after TAVI did not reduce the 4-year risk of major adverse events compared to incomplete revascularization (adjusted HR 1.01, 95% CI 0.62-1.64).