Abstract / Summary
Introduction and objectives: Coronary artery disease (CAD) is common in candidates for transcatheter aortic valve implantation (TAVI), but the benefits and optimal timing of periprocedural percutaneous coronary intervention (PCI) remain uncertain.We evaluated the prognostic impact and timing of periprocedural PCI in TAVI candidates with significant CAD.Methods: Retrospective study of patients with severe symptomatic aortic stenosis and significant CAD who underwent TAVI at a Portuguese tertiary center between 2009 and 2023.Patients received planned periprocedural PCI (≤ 6 months before or concomitant with TAVI) or optimal medical therapy.The primary endpoints were 24-month overall and cardiovascular survival.Secondary outcomes included 30-day mortality, major adverse cardiovascular events (MACE), life-threatening bleeding, periprocedural laboratory changes, and unplanned revascularization.Furthermore, propensity score matching was performed.PCI timing (before vs concomitant with TAVI) was compared.Results: Of 174 patients, 80 (46.0%) underwent PCI and 94 (54.0%) received optimal medical therapy.At 24 months, overall and cardiovascular survival were comparable (19.5 vs 18.2 months; P = .586and 22.3 vs 20.8 months; P = .182,respectively).In the propensity-matched cohort (n = 108), PCI was not associated with a survival benefit (all-cause mortality: HR, 0.98; P = .950;cardiovascular mortality: HR, 1.40; P = .610).Thirty-day mortality, MACE, bleeding, and revascularization rates did not differ significantly between groups.Among patients undergoing PCI, concomitant PCI required more contrast and longer procedures.Although the unadjusted analysis suggested lower 24-month all-cause survival with concomitant PCI, this association did not persist after multivariable adjustment.Conclusions: In TAVI candidates with obstructive CAD, planned periprocedural PCI did not improve survival compared with optimal medical therapy, even after propensity score matching.PCI timing was not associated with differences in clinical outcomes, although concomitant procedures increased procedural burden.