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Issue: May/June 2012
May 18, 2012
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PCI Found Safe in Patients with CAD, Severe AS

Issue: May/June 2012

Among patients with CAD who were treated with PCI, short-term mortality was similar between those with and without severe aortic stenosis.

Perspective from David Antoniucci, MD

The study was conducted by researchers from the Cleveland Clinic who gathered patients from the prospective interventional registry and the echocardiography database at the institution. In all, researchers examined 254 patients with severe aortic stenosis (AS) and 508 patients without severe AS who were treated with PCI between 1998 and 2008.

At 30 days, mortality was similar between those with (4.3%) and without (4.7%; P=.20 for trend) severe AS. An ejection fraction of no greater than 30% was associated with a significantly increased likelihood of 30-day post-PCI mortality when compared with those with an ejection fraction greater than 30% (15.6% vs. 1.2%; P<.001). Also indicative of a higher 30-day post-PCI mortality was a Society of Thoracic Surgeons score of at least 10 compared with an STS score of less than 10 (10.4% vs. 0%; P<.001).

For more information:

Goel SS. Circulation. 2012;125:1005-1013.

Perspective

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David Antoniucci, MD
David Antoniucci, MD

The study by Goel and colleagues addresses the very important issue of how and when to treat CAD in patients with severe AS and an indication for transcatheter aortic valve replacement. The results of the study are in many ways expected. Adjunct coronary revascularization before TAVR carries an increased risk of early death in patients with high surgical risk or severe left ventricular dysfunction.

The treatment of these patients is challenging and should be individualized according to the patient’s characteristics. At one extreme, patients with mild coronary atherosclerosis and severe aortic stenosis should not undergo PCI; conversely, patients with diffuse and severe three-vessel disease should be treated by PCI before TAVR and even after valvuloplasty if the latter is needed to decrease the risk of instability during PCI. Other variables that should be considered include renal insufficiency, age, body mass index, other comorbidities and, in general, the definition of the frailty of the patient that may have a strong impact on survival.

David Antoniucci, MD
Cardiology Today Intervention Editorial Board member
Disclosures: Dr. Antoniucci reports no relevant financial disclosures.