Claudio Montalto; Andrea Munafò; Francesco Soriano; Ketina Arslani; Stephanie Brunner; Sarah Verhemel; Ottavia Cozzi; Antonio Mangieri; Andrea Buono; Mattia Squillace; Stefano Nava; José Luis Díez Gil; Andrea Scotti; Marco Foroni; Giuseppe Esposito; Alessandro Mandurino-Mirizzi; David Bauer; Benjamin Ornelas; Pablo Codner; Kerstin Piayda; Italo Porto; Federico Marco; Horst Sievert; Ran Kornowski; Petr Tousek; Dionigi Fischetti; Azeem Latib; Jorge Sanchez; Diego Maffeo; Francesco Bedogni; Bernhard Reimers; Damiano Regazzoli; Nicolas Mieghem; Lars Søndergaard; Francesco Saia; Stefan Toggweiler; Ole Backer; Jacopo Oreglia

doi:10.4244/EIJ-D-24-00933

Outcomes of complex, high-risk percutaneous coronary intervention in patients with severe aortic stenosis: the ASCoP registry

Claudio Montalto¹^,², MD; Andrea R. Munafò¹, MD; Francesco Soriano¹, MD; Ketina Arslani³^,⁴, MD; Stephanie Brunner⁵, MD; Sarah Verhemel⁶, MD; Ottavia Cozzi⁷, MD; Antonio Mangieri⁷, MD; Andrea Buono⁸, MD; Mattia Squillace⁹, MD; Stefano Nava¹, MD; José Luis Díez Gil¹⁰, MD; Andrea Scotti¹¹, MD; Marco Foroni¹², MD; Giuseppe Esposito¹, MD, PhD; Alessandro Mandurino-Mirizzi¹³, MD; David Bauer¹⁴, MD; Benjamin De Ornelas⁸, MD; Pablo Codner¹⁵, MD; Kerstin Piayda¹⁶, MD; Italo Porto¹⁷, MD, PhD; Federico De Marco¹⁸, MD, PhD; Horst Sievert¹⁶, MD; Ran Kornowski¹⁵, MD; Petr Tousek¹⁴, MD; Dionigi Fischetti¹³, MD; Azeem Latib¹¹, MD; Jorge Sanz Sanchez¹⁰, MD; Diego Maffeo⁸, MD; Francesco Bedogni⁹, MD; Bernhard Reimers⁷, MD; Damiano Regazzoli⁷, MD; Nicolas Van Mieghem⁶, MD, PhD; Lars Sondergaard¹⁹, MD; Francesco Saia¹², MD; Stefan Toggweiler⁵, MD; Ole De Backer³^,²⁰, MD, PhD; Jacopo A. Oreglia¹, MD

Abstract

Background: There is a lack of evidence to guide treatment of patients with a concomitant indication for transcatheter aortic valve implantation (TAVI) and complex, high-risk percutaneous coronary intervention (PCI).

Aims: We aimed to assess different strategies of PCI timing in this high-risk TAVI cohort.

Methods: The ASCoP registry retrospectively included patients with a clinical indication for both TAVI and PCI with at least 1 criterion of complex or high-risk PCI. The primary endpoint was a composite of all-cause death and unplanned rehospitalisation for cardiovascular causes. The secondary endpoint was a composite of all-cause death, stroke, acute myocardial infarction, major bleeding, major vascular complication and unplanned revascularisation. Multivariable analysis was used to adjust for possible confounders.

Results: A total of 519 patients were included: 363 (69.9%) underwent staged procedures and 156 (30.1%) concomitant TAVI and PCI. After 441 (interquartile range 182-824) days, the primary endpoint occurred in 151 (36.5%) cases, without any significant difference between the 2 groups (p=0.98), while the secondary endpoint occurred more frequently in the concomitant group (n=36 [25.8%] vs n=57 [17.4%]; p=0.014).

Conclusions: In patients undergoing TAVI and complex/high-risk PCI, a concomitant strategy is associated with a higher rate of adverse events and increased procedural risk. (ClinicalTrials.gov: NCT05750927)

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