Transcatheter or surgical treatment of severe aortic stenosis and coronary artery disease: A comparative analysis from the Italian OBSERVANT study

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:270

Article

Barbanti, Marco¹  Buccheri, Sergio¹  Capodanno, Davide¹  D'Errigo, Paola²  Ranucci, Marco^3,4  Rosato, Stefano²  Santoro, Gennaro⁵  Fusco, Danilo⁶  Tamburino, Corrado¹  Biancari, Fausto⁷  Seccareccia, Fulvia² 

[1] Univ Catania, Ferrarotto Hosp, Div Cardiol, Catania, Italy

[2] Ist Super Sanita, Natl Ctr Global Hlth, Rome, Italy

[3] IRCCS Policlin San Donato, Dept Cardiothorac & Vasc Anesthesia, Milan, Italy

[4] IRCCS Policlin San Donato, ICU, Milan, Italy

[5] Careggi Hosp, Div Cardiol, Florence, Italy

[6] Lazio Reg Hlth Serv, Dept Epidemiol, Rome, Italy

[7] Oulu Univ Hosp, Dept Surg, Oulu, Finland

关键词: Aortic stenosis;    Coronary artery disease;    TAVI;    SAVR;    PCI;    CABG;   

DOI  :  10.1016/j.ijcard.2018.06.011

来源: Elsevier

【 摘 要 】

Background: To assess clinical outcomes of patients with concomitant severe aortic stenosis (AS) and coronary artery disease (CAD) who underwent transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) or surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). Methods: Data were extracted from the multicenter OBSERVANT study. For the purposes of the present analysis, we included only patients with established stable CAD meeting any of the following inclusion criteria: 1) TAVI patients with CAD undergoing staged PCI or TAVI and PCI in the same session; 2) SAVR patients undergoing combined SAVR and CABG in the same session. Results: After propensity-score matching, a total of 472 patients (236 per group) were identified. Among TAVI patients, PCI was performed prior to the procedure in 217 patients (92.0%), whereas concomitant TAVI and PCI were performed in 19 patients (8.0%). At 3-year, there was no difference in survival between the two groups (KM estimate of freedom from death for SAVR and TAVI patients of 0.742 and 0.650, respectively; log-rank p-value of 0.105). The rate of MACCE was comparable between the two groups (KM estimate of freedom from MACCE for SAVR and TAVI patients of 0.683 and 0.582, respectively; log-rank p-value of 0.115). Conclusions: In patients with associated severe AS and CAD, percutaneous treatment (TAVR and staged or concomitant PCI) was comparable to surgical treatment (SAVR and concomitant CABG) with respect to the early and mid-term risk of death from any cause, myocardial infarction, stroke and unplanned revascularization. (c) 2018 Elsevier B.V. All rights reserved.

【 授权许可】

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