Abstract 63: The Impact Of Percutaneous Coronary Intervention On Transcatheter Aortic Valve Replacement Outcomes

Background: Many patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis also have significant coronary artery disease (CAD). Although the impact of planned percutaneous coronary intervention (PCI) before TAVR has been studied, a clear strategy for timing of PCI has yet to be determined. Additionally, the effects of emergent PCI for acute coronary syndrome (ACS) prior to TAVR have not been investigated. The purpose of this study is to evaluate the impact of both emergent and planned pre-TAVR PCI on outcomes, namely major adverse cardiovascular events (MACE).

Methods: Retrospective analysis of electronic medical records from 2018-2020 at the University of Illinois at Chicago and affiliated Veterans Affairs identified all TAVR patients. Patients were placed into one of three groups: those who had TAVR within 6 months of urgent/emergent PCI for ACS, those who had TAVR within 6 months of planned PCI for stable ischemic heart disease (SIHD), and those who did not have PCI in that time period. Primary outcomes included composite MACE (all-cause mortality, MI, or CVA) at 6 and 12 months.

Results: Of 152 patients, 78% (118) were male and 56% (85) were non-white. In the 6 months prior to TAVR, 5 patients underwent PCI for ACS, 49 underwent PCI for SIHD, and 98 did not have PCI. There were no differences in co-morbidities including DM, HTN, CHF, and CKD between the three groups. No significant difference in outcomes were identified at 6 months. At 12 months, 80% (4/5) of patients with PCI for ACS had MACE compared to 20.4% (10/49) in patients with PCI for SIHD, and 14.3% (14/98) in patients with no PCI (p=0.001). All-cause mortality at 12 months was 60% (3/5) for patients with PCI for ACS, 12.2% (6/49) for patients with PCI for SIHD, and 13.3% (13/98) for patients with no PCI (p=0.01).

Conclusion: Our findings suggest that patients requiring PCI for ACS close to TAVR are at higher risk for poor outcomes compared to those with non-emergent PCI, or no PCI. Their 12 month mortality also exceeds expected mortality for patients who undergo PCI for ACS without TAVR. For this reason, these patients may require more careful follow up post-procedurally. It remains uncertain whether delay of TAVR for these patients improves outcomes.