System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Observational Study Multicenter Study Ppublish

PubMed: 42838145 DOI: 10.1016/j.ijcard.2026.134968

Timing of revascularisation in patients undergoing high-risk percutaneous coronary intervention and Transcatheter aortic valve implantation: insights from the ASCoP registry.

Int J Cardiol 465:134968

Authors: Andrea R Munafò, Giuseppe Esposito, Arif Khokhar, Stephanie Brunner, Sarah Verhemel, Alice Annalisa Cerutti, Sara Ceni, Damiano Regazzoli, Andrea Buono, Mattia Squillace, Stefano Nava, Andrea Sultana, José Luis Díez Gil, Omar Olivier, Andrea Scotti, Alessandro Mandurino-Mirizzi, David Bauer, Pablo Codner, Michelangelo Carbonara, Antonio Mangieri, Horst Sievert, Italo Porto, Petr Toušek, Dionigi Fischetti, Azeem Latib, Jorge Sanz Sanchez, Diego Maffeo, Francesco Bedogni, Bernhard Reimers, Nicholas Van Mieghem, Francesco Saia, Francesco Soriano, Stefan Toggweiler, Jacopo A Oreglia, Ole De Backer, Claudio Montalto

Affiliations

  • Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy.
  • The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  • Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland.
  • Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
  • Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy.
  • Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
  • IRCCS Policlinico S. Donato, Milan, Italy.
  • Hospital Universitario y Politécnico La Fe, Valencia, Spain.
  • Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
  • Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
  • Cardiology Department, Vito Fazzi Hospital, Lecce, Italy.
  • Department of Cardiology, Third Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, 100 34 Prague, Czech Republic.
  • Department of Cardiology Rabin Medical Center Petah Tikva, Israel.
  • CardioVascular Center Frankfurt (CVC), Frankfurt, Germany.
  • Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy.
  • Interventional Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy.
  • The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  • Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.

Abstract

BACKGROUND

Evidence on the management of complex and high-risk coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still limited. In particular, the optimal timing of percutaneous coronary intervention (PCI) relative to TAVI remains uncertain.

METHODS

The ASCop is an observational, multicenter registry that retrospectively enrolled patients with a clinical indication for both TAVI and high-risk PCI. For the purpose of this analysis, patients were divided into three groups according to the PCI timing strategy used: PCI concomitant to TAVI, PCI before TAVI, and PCI after TAVI. The primary endpoint was a composite of all-cause death and first unplanned hospitalisation. The secondary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE). A propensity score methodology with inverse probability of treatment weighting (IPTW) was performed to account for selection bias between the three treatment groups.

RESULTS

Of the 519 patients included in the registry, 156 (30.1%) underwent high-risk PCI during the same TAVI procedure, 333 (64.1%) received PCI before TAVI, while in 30 cases (5.8%) PCI was performed after TAVI. At 1-year follow-up, adopting a strategy of staging PCI after TAVI was associated with a higher incidence of the primary endpoint (HR 2.31, 95%CI:1.24-4.32; p-value = 0.008), while staging PCI before TAVI was associated with a lower incidence of MACCE (HR 0.55, 95%CI:0.35-0.85; p-value = 0.008). Results were consistent after IPTW adjustment.

CONCLUSIONS

In this high-risk TAVI cohort, the strategy of staging high-risk PCI after TAVI was associated with an increased risk of adverse events at 1-year.

MeSH

Registries, Incidence, Percutaneous Coronary Intervention, Aortic Valve, Transcatheter Aortic Valve Replacement, Therapeutics