Clinical impact of complex percutaneous coronary intervention in the pre-TAVR workup

February 20, 2025

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Publicated to:Rev Esp Cardiol (Engl Ed). 78 (2): 82-93 - 2025-02-01 78(2), DOI: 10.1016/j.rec.2024.05.002

Authors: Avvedimento, Marisa; Campelo-Parada, Francisco; Nombela-Franco, Luis; Fischer, Quentin; Donaint, Pierre; Serra, Vicenc; Veiga, Gabriela; Gutierrez, Enrique; Franzone, Anna; Vilalta, Victoria; Alperi, Alberto; Regueiro, Ander; Asmarats, Lluis; Ribeiro, Henrique B; Matta, Anthony; Munoz-Garcia, Antonio; Tirado, Gabriela; Urena, Marina; Metz, Damien; Rodenas-Alesina, Eduard; Hernandez, Jose Maria de la Torre; Angellotti, Domenico; Fernandez-Nofrerias, Eduard; Pascual, Isaac; Vidal-Cales, Pablo; Arzamendi, Dabit; Campanha-Borges, Diego Carter; Trinh, Kim Hoang; Nuche, Jorge; Cote, Melanie; Faroux, Laurent; Rodes-Cabaua, Josep

Affiliations

Hop Univ Toulouse, Cardiol Dept, Toulouse, France - Author

Hopitaux Paris, AP HP, Grp Hosp Bichat Claude Bernard, F-75877 Paris, France - Author

Hosp Badalona Germans Trias & Pujol, Serv Cardiol, Badalona, Barcelona, Spain - Author

Hosp Clin San Carlos, Inst Cardiovasc, Serv Cardiol, IdISSC, Madrid, Spain - Author

Hosp Gregorio Maranon, Serv Cardiol, Madrid, Spain - Author

Hosp Marques Valdecilla, Serv Cardiol, Santander, Cantabria, Spain - Author

Hosp Santa Creu & Sant Pau, Serv Cardiol, Barcelona, Spain - Author

Hosp Univ Cent Asturias, Serv Cardiol, Oviedo, Asturias, Spain - Author

Hosp Univ Vall dHebron, Serv Cardiol, Barcelona, Spain - Author

Hosp Univ Virgen Victoria, Serv Cardiol, Malaga, Spain - Author

Inst Invest Biomed August Pi & Sunyer IDIBAPS, Serv Cardiol, Hosp Clin, Inst Clin Cardiovasc, Barcelona, Spain - Author

Laval Univ, Quebec Heart & Lung Inst, Quebec City, PQ, Canada - Author

Reims Univ Hosp, Cardiol Dept, F-51100 Reims, France - Author

Univ Naples Federico II, Dept Adv Biomed Sci, Naples, Italy - Author

Univ Sao Paulo, Heart Inst InCor, Dept Clin Cardiol, Sao Paulo, Brazil - Author

Abstract

Introduction and objectives: In patients undergoing percutaneous coronary intervention (PCI) in the workup pre-transcatheter aortic valve replacement (TAVR), the clinical impact of coronary revascularization complexity remains unknown. This study sought to examine the impact of PCI complexity on clinical outcomes after TAVR in patients undergoing PCI in the preprocedural workup. Methods: This was a multicenter study including consecutive patients scheduled for TAVR with concomitant significant coronary artery disease. Complex PCI was defined as having at least 1 of the following features: 3 vessels treated, >= 3 stents implanted,>= 3 lesions treated, bifurcation with 2 stents implanted, total stent length > 60 mm, or chronic total occlusion. The rates of major adverse cardiac events (MACE), including cardiovascular mortality, myocardial infarction, and coronary revascularization were evaluated. Results: A total of 1550 patients were included, of which 454 (29.3%) underwent complex PCI in the preTAVR workup. After a median follow-up period of 2 [1-3] years after TAVR, the incidence of MACE was 9.6 events per 100 patients-years. Complex PCI significantly increased the risk of cardiac death (HR, 1.44; 95%CI, 1.01-2.07), nonperiprocedural myocardial infarction (HR, 1.52; 95%CI, 1.04-2.21), and coronary revascularization (HR, 2.46; 95%CI, 1.44-4.20). In addition, PCI complexity was identified as an independent predictor of MACE after TAVR (HR, 1.31; 95%CI, 1.01-1.71; P = .042). Conclusions: In TAVR candidates with significant coronary artery disease requiring percutaneous treatment, complex revascularization was associated with a higher risk of MACE. The degree of procedural complexity should be considered a strong determinant of prognosis in the PCI-TAVR population. (C) 2024 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Keywords

Aortic-valve implantationComplex pcComplex pciDiseasDual antiplatelet therapyIcpIcp complejaImplante percutáneo de válvula aórticaIntervención coronaria percutáneaMonotherapyOutcomesPciPercutaneous coronary interventionRevascularizationStent thrombosisTaviTavrTranscatheter aortic valve replacement

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Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Rev Esp Cardiol (Engl Ed) due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2025, it was in position 43/230, thus managing to position itself as a Q1 (Primer Cuartil), in the category Cardiac & Cardiovascular Systems.

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Brazil; Canada; France; Italy.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (Rodes-Cabaua, Josep).

the author responsible for correspondence tasks has been Rodes-Cabaua, Josep.

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