Impact of Extent of Coronary Artery Disease in Transcatheter Aortic Valve Replacement: A PRO-TAVI Substudy.
Gijs M Broeze, Hugo M Aarts, Johanna da Silva Voorham et al.
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In 30 seconds
This post hoc substudy of the multicentre randomised PRO-TAVI trial examined whether coronary disease complexity, measured by SYNTAX score, was associated with outcomes among 466 patients with significant coronary artery disease undergoing TAVR. Patients had been randomised to PCI before TAVR or PCI deferral. At 1 year, the primary composite outcome did not differ between strategies across SYNTAX categories. Among patients with SYNTAX score >17, the ischemic composite occurred more often with PCI deferral than with PCI (30.9% vs 14.8%; adjusted HR: 2.43; 95% CI: 1.04-5.64; P = 0.04), while bleeding was less frequent with deferral across subgroups.
Key findings
- The primary composite outcome did not differ between PCI deferral and PCI across SYNTAX score categories at 1 year.
- With SYNTAX score >17, the ischemic composite occurred in 30.9% with deferral versus 14.8% with PCI (adjusted HR: 2.43; 95% CI: 1.04-5.64; P = 0.04).
- Bleeding events were less frequent with PCI deferral across all SYNTAX subgroups.
Why it matters
The findings suggest that coronary disease complexity may be relevant when weighing PCI timing in patients undergoing TAVR: deferral was associated with fewer bleeding events, but patients with higher SYNTAX scores had more ischemic events with deferral. This highlights a potential trade-off between bleeding and ischemic outcomes, while the post hoc nature of the analysis means the subgroup result should be interpreted cautiously.
What to keep in mind
This was a post hoc substudy, and the authors state that the findings require confirmation in randomized trials.