Comparison of Staged and Concomitant Percutaneous Coronary Intervention in Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Cohort Study.
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Abstract
Aim: This study aims to compare the clinical outcomes of concomitant versus staged percutaneous coronary intervention (PCI) in patients with severe aortic valve disease and significant coronary artery stenosis undergoing transcatheter aortic valve replacement (TAVR).
Methods: We retrospectively analyzed 180 patients with severe aortic valve disease and significant coronary artery stenosis who underwent TAVR with PCI during the same hospitalization. Patients were treated using either a concomitant strategy (PCI and TAVR performed on the same day) or a staged strategy (procedures performed on different days). Procedural success, valve hemodynamics, and perioperative complications were compared between strategies.
Results: Overall procedural success was achieved in 168 of 180 patients (93.3%), without a significant difference between the concomitant and staged groups (92.2% vs. 97.4%, p = 0.467). Transvalvular pressure gradients decreased markedly after TAVR in both groups, from 81.7 (66.3, 99.6) mmHg to 20.0 (12.7, 24.8) mmHg in the concomitant group and from 75.2 (63.2, 97.8) mmHg to 14.9 (8.4, 27.3) mmHg in the staged group (both p < 0.001). Perioperative mortality occurred in 6 (4.3%) patients in the concomitant group and in none of the staged group (p = 0.343). Rates of permanent pacemaker implantation (1.4% vs. 0%), myocardial infarction (0.7% vs. 2.6%), major bleeding (2.1% vs. 0%), stroke (5.0% vs. 0%), and acute kidney injury (13.5% vs. 12.8%) were infrequent in both groups (all p-values > 0.05).
Conclusions: In this cohort, both concomitant and staged PCI strategies achieve high procedural success, and no statistically significant differences in early clinical outcomes are observed between the two strategies. Nevertheless, the definitive optimal timing of PCI remains to be elucidated by future large-scale studies with extended follow-up.
目的：本研究旨在比较严重主动脉瓣病变和严重冠状动脉狭窄患者行经导管主动脉瓣置换术（TAVR）的合并与分期经皮冠状动脉介入治疗（PCI）的临床结果。方法：回顾性分析180例在同一住院期间行TAVR合并PCI的严重主动脉瓣疾病和明显冠状动脉狭窄患者。患者采用联合策略（PCI和TAVR在同一天进行）或分阶段策略（在不同日期进行手术）进行治疗。手术成功率、瓣膜血流动力学和围手术期并发症的比较。结果：180例患者中有168例（93.3%）手术总体成功，合并组和分期组之间无显著差异（92.2%比97.4%,p = 0.467）。两组TAVR后经瓣压力梯度均显著降低，合并组从81.7 (66.3,99.6)mmHg降至20.0 (12.7,24.8)mmHg，分阶段组从75.2 (63.2,97.8)mmHg降至14.9 (8.4,27.3)mmHg （p均< 0.001）。合并组有6例（4.3%）患者出现围手术期死亡率，而分期组均无患者出现围手术期死亡率（p = 0.343）。永久性起搏器植入（1.4% vs. 0%）、心肌梗死（0.7% vs. 2.6%）、大出血（2.1% vs. 0%）、中风（5.0% vs. 0%）和急性肾损伤（13.5% vs. 12.8%）的发生率在两组中均不常见（所有p值均为bb0 0.05）。结论：在本队列中，合并PCI和分期PCI策略均获得较高的手术成功率，两种策略的早期临床结果无统计学差异。然而，确切的PCI最佳时机仍需通过未来的大规模随访研究来阐明。
期刊介绍：
Annali Italiani di Chirurgia is a bimonthly journal and covers all aspects of surgery:elective, emergency and experimental surgery, as well as problems involving technology, teaching, organization and forensic medicine. The articles are published in Italian or English, though English is preferred because it facilitates the international diffusion of the journal (v.Guidelines for Authors and Norme per gli Autori). The articles published are divided into three main sections:editorials, original articles, and case reports and innovations.
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