NEW YORK (Reuters Health) – Performing percutaneous coronary interventions for coronary artery disease is feasible before transcatheter aortic valve implantation (TAVI), and the strategy appears safe, according to a report from Germany appearing online December 2nd in the American Journal of Cardiology.

However, while this approach does not increase procedural risk, the authors acknowledge that “whether and when myocardial revascularization is needed before TAVI cannot be answered by the present study.”

Dr. Mohamed Abdel-Wahab at the Academic Teaching Hospital of the Universities of Kiel and Hamburg, Bad Segeberg, and colleagues explain that TAVI has become a favored treatment for patients with severe aortic stenosis who are at high surgical risk. Treating concomitant coronary artery disease might be beneficial in this setting, but the impact f PCI before TAVI has not been examined.

The current study aimed to address the safety and feasibility of preprocedural PCI in patients with significant coronary artery disease also undergoing TAVI with a Medtronic CoreValve prosthesis. Among 125 such patients, 55 had PCI performed up to 3 months before TAVI (median interval 10 days) or as a concomitant procedure, while 70 underwent only TAVI.

Adjusted endpoints at 30 days were similar in the two arms, the investigators found. All cause mortality was 2% among the PCI+TAVI group and 6% in the TAVI-only group, but the difference was not statistically significant (p=0.27). Rates of 30-day stroke were 2% vs 6% (p=0.27) and major vascular complications occurred in 6% vs 3% (p=0.46).

Cumulative 6-month events were also similar in the two arms. Dr. Abdel-Wahab and colleagues found.

“Based on these early results revascularization should become an important consideration in patients with coronary artery disease undergoing TAVI,” they conclude.

Nonetheless, they add, “Because elderly patients with severe aortic stenosis and CAD usually have overlapping symptoms and TAVI alone significantly improves their survival, a randomized trial to determine whether additional PCI would add to this survival advantage is justified and needed.”

Reference:

Am J Cardiol 2012