Trends and outcomes of combined percutaneous (TAVI+PCI) and surgical approach (SAVR+CABG) for patients with aortic valve and coronary artery disease: A National Readmission Database (NRD) analysis
Catheterization and Cardiovascular Interventions
Background: In patients with severe aortic stenosis (AS) and concomitant severe coronary artery disease (CAD), the relative merits of a combined percutaneous (transcatheter aortic valve implantation [TAVI] and percutaneous coronary intervention [PCI]] versus surgical approach (surgical aortic valve replacement [SAVR] and coronary artery bypass graft [CABG]) remain unknown.
Aims: To determine the utility of combined percutaneous versus surgical approaches in patients with severe AS and CAD.
Methods: The National Readmission Database (NRD) (2015-2019) was queried to identify all cases of TAVI+PCI and SAVR+CABG. The adjusted odds ratios (aOR) of mortality, stroke, and its composite (major adverse cardiovascular events [MACE]) were calculated using a propensity-score matched (PSM) analysis.
Results: A total of 89,314 (5358 TAVI+PCI, 83,956 SAVR+CABG) patients were included in the crude analysis. There was a gradual increase in the utilization of TAVI+PCI from 2016 to 2019 by 2%-4% per year. Using PSM, a subset of 11,361 (5358 TAVI+PCI, 6003 SAVR+CABG) patients with a balanced set of demographics and baseline comorbidities was selected. During index hospitalization, the adjusted odds of MACE (aOR 0.72, 95% confidence interval [CI] 0.62-0.83), and all-cause mortality (aOR 0.68, 95% CI 0.57-0.81) were significantly lower in patients undergoing TAVI+PCI compared with SAVR+CABG. However, patients undergoing TAVI+PCI had a higher incidence of MACE (aOR 1.40, 95% CI 1.05-1.87), and mortality (aOR 1.75, 95% CI 1.22-2.50) at 30-days. The risk of index-admission (aOR 0.82, 95% CI 0.62-1.09) and 30-day (aOR 0.88, 95% CI 0.51-1.51) stroke was similar between the two groups.
Conclusion: In selected patients with severe AS and concomitant CAD, a combined percutaneous approach (TAVR+PCI) compared with SAVR+CABG may confer a lower risk of MACE and mortality during index admission but a higher incidence of 30-day complications.
Medical Subject Headings
Humans; Aortic Valve (diagnostic imaging, surgery); Transcatheter Aortic Valve Replacement; Coronary Artery Disease (diagnostic imaging, surgery); Percutaneous Coronary Intervention (adverse effects); Patient Readmission; Aortic Valve Stenosis (diagnostic imaging, surgery, complications); Treatment Outcome; Coronary Artery Bypass; Heart Valve Prosthesis Implantation; Stroke (etiology); Risk Factors
Ullah, W., Sarvepalli, D., Kumar, A., Zahid, S., Saleem, S., Muhammadzai, H. Z., Khattak, F., Block, P. C., Jaber, W. A., Shishehbor, M. H., Filby, S. J., & Devireddy, C. (2023). Trends and outcomes of combined percutaneous (TAVI+PCI) and surgical approach (SAVR+CABG) for patients with aortic valve and coronary artery disease: A National Readmission Database (NRD) analysis. Catheterization and Cardiovascular Interventions, 102 (5), 946-957. https://doi.org/10.1002/ccd.30832