Interventions for valvular disease and heart failure

Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation

EuroIntervention 2023;19:589-599. DOI: 10.4244/EIJ-D-23-00186

Tobias Rheude
Tobias Rheude1, MD; Giuliano Costa2, MD; Flavio Luciano Ribichini3, MD; Thomas Pilgrim4, MD; Ignacio J. Amat Santos5, MD; Ole De Backer6, MD; Won‐Keun Kim7, MD; Henrique Barbosa Ribeiro8, MD; Francesco Saia9, MD; Matjaz Bunc10, MD; Didier Tchétché11, MD; Philippe Garot12, MD; Darren Mylotte13, MD; Francesco Burzotta14, MD; Yusuke Watanabe15, MD; Francesco Bedogni16, MD; Tullio Tesorio16, MD; Marco Tocci17, MD; Anna Franzone18, MD; Roberto Valvo19, MD; Mikko Savontaus20, MD; Hendrik Wienemann21, MD; Italo Porto22, MD; Caterina Gandolfo23, MD; Alessandro Iadanza24, MD; Alessandro S. Bortone25, MD, PhD; Markus Mach26, MD; Azeem Latib27, MD; Luigi Biasco28, MD; Maurizio Taramasso29, MD; Marco Zimarino30, MD; Daijiro Tomii4, MD; Philippe Nuyens6, MD; Lars Sondergaard31, MD, PhD; Sergio F. Camara8, MD; Tullio Palmerini9, MD; Mateusz Orzalkiewicz9, MD; Klemen Steblovnik10, MD; Bastien Degrelle11, MD; Alexandre Gautier12, MD; Paolo Alberto Del Sole3, MD; Andrea Mainardi3, MD; Michele Pighi3, MD; Mattia Lunardi3,13, MD, MSc; Hideyuki Kawashima15, MD; Enrico Criscione16, MD; Vincenzo Cesario32, MD; Fausto Biancari33, MD; Federico Zanin33, MD; Giovanni Esposito18, MD; Matti Adam21, MD; Eberhard Grube21, MD, PhD; Stephan Baldus21, MD; Vincenzo De Marzo22, MD; Elisa Piredda22, MD; Stefano Cannata23, MD; Fortunato Iacovelli25, MD, PhD; Martin Andreas26, MD, PhD; Valentina Frittitta19, MD; Elena Dipietro19, MD; Claudia Reddavid19, MD; Orazio Strazzieri19, MD; Silvia Motta19, MD; Domenico Angellotti18, MD; Carmelo Sgroi2, MD; Erion Xhepa1, MD; Faraj Kargoli27, MD; Corrado Tamburino2, MD, PhD; Michael Joner1, MD; Marco Barbanti2,34, MD
1. Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany; 2. Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, Catania, Italy; 3. Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; 4. Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 5. CIBERCV, Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; 6. The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 7. Kerckhoff Heart Center, Bad Nauheim, Germany; 8. Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil; 9. Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy; 10. University Medical Centre Ljubljana, Ljubljana, Slovenia; 11. Clinique Pasteur, Toulouse, France; 12. Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France; 13. Galway University Hospital, Galway, Ireland; 14. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; 15. Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan; 16. Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy; 17. Division of Cardiology, Policlinico Umberto I, Roma, Italy; 18. Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy; 19. University of Catania, Catania, Italy; 20. Heart Center, Turku University Hospital, Turku, Finland; 21. Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany; 22. Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy; 23. Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy; 24. UOSA Cardiologia Interventistica, Azienda ospedaliera-universitaria Senese, Policlinico Le Scotte, Siena, Italy; 25. Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy; 26. Wien University Hospital, Vienna, Austria; 27. Montefiore Medical Center, New York, NY, USA; 28. Azienda Sanitaria Locale di Ciriè, Chivasso e Ivrea, ASL TO4, Ivrea, Italy; 29. HerzZentrum Hirslanden Zürich, Zürich, Switzerland; 30. Department of Cardiology, SS. Annunziata Hospital Chieti, ASL 2 Abruzzo, Chieti, Italy and Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy; 31. Abbott Structural Heart, Santa Clara, CA, USA; 32. Sant’Andrea Hospital, Sapienza University, Rome, Italy; 33. Clinica Montevergine, GVM Care & Research, Mercogliano, Italy; 34. Università degli Studi di Enna “Kore”, Enna, Italy

Background: The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown.

Aims: We sought to compare different PCI timing strategies in TAVI patients.

Methods: The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method.

Results: A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days.

Conclusions: In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

aortic stenosiscoronary artery diseasetavi
Read next article
Transcatheter edge-to-edge repair with the PASCAL device for failed MitraClip procedure

Latest news