International Journal of Cardiology 179 (2015) 258–261
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Early outcomes of isolated transcatheter aortic valve implantation versus combined with percutaneous coronary intervention Kevin Phan, Sophia Wong, Steven Phan, Tristan D. Yan ⁎ The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
a r t i c l e
i n f o
Article history: Received 3 November 2014 Accepted 5 November 2014 Available online 6 November 2014 Keywords: Transcatheter aortic valve implantation Percutaneous coronary intervention TAVI TAVR
While transcatheter aortic valve implantation (TAVI) has been shown to be a suitable and effective alternative in high-risk inoperable patients with aortic stenosis (AS) [1], there is limited evidence available for the ideal treatment approach in patients with AS and coronary artery disease (CAD). Observational trials have shown that up to two thirds of AS patients present with significant coronary lesions [2], and in surgical candidates this may be managed with a combination of coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR). While it is known that CABG in addition to SAVR increases perioperative mortality [3], it remains to be seen if the addition of percutaneous coronary intervention (PCI) will worsen outcomes in patients undergoing TAVI. Current surgical guidelines continue to recommend revascularization as this strategy improves both long- and short-term survival after SAVR [4,5]. Our meta-analysis aims to determine the impact of PCI on the prognosis of patients undergoing TAVI. Electronic searches were performed using six electronic databases, using the terms “transcatheter aortic valve”, “percutaneous coronary intervention”, and “stenting” as key words or MeSH headings. Inclusion criteria included studies comparing TAVI versus TAVI + PCI approaches, with at least 10 patients in each cohort. When institutions published duplicate studies with accumulating numbers of patients or increased lengths of follow-up, only the most complete reports were included for quantitative assessment at each time interval. Abstracts, case reports, conference presentations, editorials, and expert opinions were ⁎ Corresponding author at: Cardiovascular and Thoracic Surgery, Macquarie University Hospital, Sydney, Australia; The Collaborative Research (CORE) Group, Macquarie University, 2 Technology Place, Sydney, Australia. E-mail address: [email protected] (T.D. Yan).
http://dx.doi.org/10.1016/j.ijcard.2014.11.050 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
excluded. Meta-analysis was performed by combining extracted data as pooled incidence of mortality or complications. The relative risk (RR) was used as a summary statistic for dichotomous variables, and weighted mean difference (WMD) for continuous variables. The DerSimonian– Laird random effects model was used. χ2 tests were used to study heterogeneity between trials. Five studies [2,6–9] met the inclusion criteria involving 1634 patients. Baseline characteristics are summarized in Table 1. One study used a one-stage approach [6] while two studies [8,9] performed PCI first then TAVI and two studies [2,7] looked at both staged and simultaneous procedures. Of the included patients, 1318 underwent TAVI compared with 316 patients undergoing both TAVI and PCI. There was no significant difference found between isolated TAVI and TAVI plus PCI cohorts in terms of 30-day mortality (RR, 0.80; 95% CI, 0.35–1,83; I2 = 52%; P = 0.60) (Fig. 1) with no significant heterogeneity detected. Rates of post-operative myocardial infarction between both cohorts were also comparable (RR, 0.34; 95% CI, 0.09–1.29; I2 = 21%; P = 0.11). Stroke rate was similar (RR, 1.12; 95% CI, 0.43–2.94; I2 = 0%; P = 0.81) as was the combined safety endpoint (RR, 1.18; 95% CI, 0.78–1.77; I2 = 0%; P = 0.43). Looking at the secondary outcomes (Fig. 2), rate of major bleeding was similar between both cohorts (RR, 0.85; 95% CI, 0.63–1.15; I2 = 0%; P = 0.29). The rates of major vascular access complications (RR, 0.77; 95% CI, 0.38–1.60; I2 = 0%; P = 0.49) and requirement for new pacemakers (RR, 0.88; 95% CI, 0.67–1.16; I2 = 3%; P = 0.36) are also comparable. Surprisingly, the isolated TAVI cohort had a similar rate of renal failure to those undergoing both TAVI and PCI (RR, 1.37; 95% CI, 0.90–2.10; I2 = 0%; P = 0.14). This meta-analysis suggests that performing PCI in addition to TAVI is a feasible and safe option with acceptable 30-day mortality, myocardial infarction, stroke risk and combined safety end points. This is in contrast to outcomes seen with the surgical approach in which the addition of CABG doubles peri-operative death rates from 3% in isolated SAVR to 7% in combined SAVR and CABG [3,10,11]. We did not find an increased risk of major bleeding in the cohort undergoing TAVI and PCI, despite the need for dual anti-platelet therapy in this group. There was also no increase in vascular access complications in the TAVI plus PCI group, although repeated vascular punctures had to be made. Most interestingly, we did not find a higher rate of renal failure in the patients undergoing both PCI and TAVI, despite a greater exposure to contrast medium in this group. The absence of increased rates of renal failure in the cohort undergoing multiple procedures is consistent with a recent study which showed that the amount of contrast agent delivered did not affect the risk of developing acute kidney injury after
K. Phan et al. / International Journal of Cardiology 179 (2015) 258–261
259
Table 1 Study characteristics.
Country Study period No. patients Age Male BMI (kg/m2) log EuroScore (%) Atrial fibrillation (%) Stroke/CVA (%) Peripheral artery disease (%) Prior pacemaker/ICD Prior CABG (%) Prior PCI (%) Hypertension (%) Dyslipidemia (%) Prior MI (%) LVEF (%) Aortic valve area (cm2) Peak gradient (mm Hg) Mean gradient (mm Hg)
Penkella
Griese
TAVI
TAVI
TAVI + PCI
Germany 2008–2013 517 76 80.4 83 67 72.5 27.3 26.0 ± 4.6 26.2 32.1 31.1 17.1 22.2 19.7 62 65.8 9.5 9.2 0 0 NA NA NA NA NA NA NA NA 55.5 55 0.68 0.64 ± 0.17 NA NA 48.3 47.3 ± 16.2
Germany 2009–2012 346 82 ± 5 37 NA 20.3 ± 14.6 47 10 NA NA NA 15 NA NA NA 54 ± 14 NA NA NA
Abramowitz TAVI + PCI
TAVI
65 82 ± 6 36 NA 21.7 ± 13.9 46 12 NA NA NA 15 NA NA NA 52 ± 15 NA NA NA
Israel 2009–2012 188 83 35 27.3 24.7 ± 13.8 NA 8.5 10.1 9 14.1 28.7 83.5 76.6 13.3 56.4 0.688 79 47.8
Abdel-Wahab TAVI + PCI
TAVI
61 83.6 50.8 27.2 31.3 NA 8.2 16.4 6.6 23 21.3 90.2 82 18 54.6 0.67 75.7 45.9
Germany 2007–2011 70 81 ± 6.20 49 26.40 ± 4.27 23.62 ± 15.10 NA 13 14 NA 23 33 80 60 26 48.54 ± 15.25 0.69 ± 0.21 78.54 ± 26.14 50.32 ± 16.90
± 5.5 ± 4.1 ± 13.8
± ± ± ±
9 0.14 25.4 17.2
Wenaweser TAVI + PCI
TAVI
TAVI + PCI
55 81 ± 7.06 47 27.87 ± 6.52 25.08 ± 12.58 NA 7 20 NA 15 27 84 71 26 46.92 ± 13.85 0.68 ± 0.20 77.00 ± 19.85 49.88 ± 13.74
Switzerland 2007–2010 197 81.7 ± 6.5 42.1 26.1 ± 5.0 24.2 ± 14.4 24.4 8.6 24.4 7.1 21.8 17.3 77.2 NA 15.7 51 ± 15 0.7 ± 0.2 NA 45.1 ± 16.9
59 83.6 ± 4.8 49.2 25.0 ± 4.3 26.8 ± 16.3 30.5 10.2 27.1 20.3 18.6 40.7 81.4 NA 27.1 51 ± 12 0.7 ± 0.2 NA 42.1 ± 17.3
TAVI, transcatheter aortic valve implantation; PCI, percutaneous coronary intervention; NA, not available; BMI, body mass index; CVA, cerebrovascular accident; ICD, implantable cardioverter defibrillator; CABG, coronary artery bypass graft; MI, myocardial infarction; LVEF, left ventricular ejection fraction.
TAVI [12]. First, careful patient selection might play a role in minimizing procedural complications. For instance, given the lack of randomization it is possible that only patients with a high likelihood of procedural success, such as those with easily accessible proximal lesions, were chosen for the joint PCI and TAVI strategy. Second, the duration between TAVI and PCI (where a staged strategy was chosen) might have allowed for vascular and renal healing between procedures. The results of our meta-analysis show that performing PCI in addition to TAVI does not result in a difference in short term outcomes for patients. It is important to note however that some studies have shown poorer long-term complications and mortality in the TAVI plus PCI group [7] but due to a lack of available data, we were unable to perform a meta-analysis on long-term outcomes. This meta-analysis is constrained by several limitations. There were only a small number of studies that could be included for analysis, and the small number of patients may limit statistical power. All included studies were observational and lacked randomization and propensitymatching. Only one study was prospective and four were retrospective, which introduces selection bias. There was insufficient data on longterm outcomes so this could not be evaluated. There was also heterogeneity between studies in terms of the type of stents used, vessel disease, TAVI valves and approach and anti-coagulation protocol. Different scoring systems were used to evaluate severity of CAD. In conclusion, percutaneous revascularization does not appear to affect the short-term mortality and complication rates in patients undergoing TAVI. There are a few directions we can take from here. (1) Studies are needed to establish the long-term impact of PCI on patients undergoing TAVI; (2) More data is needed to determine if there is a difference in outcomes for simultaneous versus staged procedures; (3) If staged procedures result in favorable outcomes, further studies should investigate the optimal duration allowed between TAVI and PCI procedures. Conflicts of interest The authors report no relationships that could be construed as a conflict of interest. Funding None.
Acknowledgment None. References [1] M.B. Leon, C.R. Smith, M. Mack, D.C. Miller, J.W. Moses, L.G. Svensson, et al., Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery, N. Engl. J. Med. 363 (2010) 1597–1607. [2] P. Wenaweser, T. Pilgrim, E. Guerios, S. Stortecky, C. Huber, A.A. Khattab, et al., Impact of coronary artery disease and percutaneous coronary intervention on outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation, EuroIntervention 7 (2011) 541–548. [3] F.H. Edwards, E.D. Peterson, L.P. Coombs, E.R. DeLong, W.R. Jamieson, A.L.W. Shroyer, et al., Prediction of operative mortality after valve replacement surgery, J. Am. Coll. Cardiol. 37 (2001) 885–892. [4] O. Lund, T.T. Nielsen, H.K. Pilegaard, K. Magnussen, M.A. Knudsen, The influence of coronary artery disease and bypass grafting on early and late survival after valve replacement for aortic stenosis, J. Thorac. Cardiovasc. Surg. 100 (1990) 327–337. [5] S. Windecker, P. Kolh, F. Alfonso, J.P. Collet, J. Cremer, V. Falk, et al., 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), EuroIntervention (2014), http://dx.doi.org/10.4244/EIJY14M09_01 [Epub ahead of print]. [6] A. Penkalla, M. Pasic, T. Drews, S. Buz, S. Dreysse, M. Kukucka, et al., Transcatheter aortic valve implantation combined with elective coronary artery stenting: a simultaneous approach, Eur. J. Cardiothorac. Surg. (2014), http://dx.doi.org/10.1093/ ejcts/ezu339 [Epub ahead of print]. [7] D.P. Griese, W. Reents, A. Toth, S. Kerber, A. Diegeler, J. Babin-Ebell, Concomitant coronary intervention is associated with poorer early and late clinical outcomes in selected elderly patients receiving transcatheter aortic valve implantation, Eur. J. Cardiothorac. Surg. 46 (2014) e1–e7. [8] Y. Abramowitz, S. Banai, G. Katz, A. Steinvil, Y. Arbel, O. Havakuk, et al., Comparison of early and late outcomes of TAVI alone compared to TAVI plus PCI in aortic stenosis patients with and without coronary artery disease, Catheter. Cardiovasc. Interv. 83 (2014) 649–654. [9] M. Abdel-Wahab, A.E. Mostafa, V. Geist, B. Stocker, K. Gordian, C. Merten, et al., Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention, Am. J. Cardiol. 109 (2012) 581–586. [10] S.M. O'Brien, D.M. Shahian, G. Filardo, V.A. Ferraris, C.K. Haan, J.B. Rich, et al., The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery, Ann. Thorac. Surg. 88 (2009) S23–S42. [11] D.M. Shahian, S.M. O'Brien, G. Filardo, V.A. Ferraris, C.K. Haan, J.B. Rich, et al., The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3—valve plus coronary artery bypass grafting surgery, Ann. Thorac. Surg. 88 (2009) S43–S62. [12] N. Goebel, H. Baumbach, S. Ahad, M. Voehringer, S. Hill, M. Albert, et al., Transcatheter aortic valve replacement: does kidney function affect outcome? Ann. Thorac. Surg. 96 (2013) 507–512.
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K. Phan et al. / International Journal of Cardiology 179 (2015) 258–261
Fig. 1. Forest plots of 30-day mortality, myocardial infarctions, strokes/TIA, and combined safety endpoint.
K. Phan et al. / International Journal of Cardiology 179 (2015) 258–261
Fig. 2. Forest plots of major bleeding, renal failure, major vascular access complications, and new pacemakers.
261
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Early outcomes of isolated transcatheter aortic valve implantation versus combined with percutaneous coronary intervention Kevin Phan, Sophia Wong, Steven Phan, Tristan D. Yan ⁎ The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
a r t i c l e
i n f o
Article history: Received 3 November 2014 Accepted 5 November 2014 Available online 6 November 2014 Keywords: Transcatheter aortic valve implantation Percutaneous coronary intervention TAVI TAVR
While transcatheter aortic valve implantation (TAVI) has been shown to be a suitable and effective alternative in high-risk inoperable patients with aortic stenosis (AS) [1], there is limited evidence available for the ideal treatment approach in patients with AS and coronary artery disease (CAD). Observational trials have shown that up to two thirds of AS patients present with significant coronary lesions [2], and in surgical candidates this may be managed with a combination of coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR). While it is known that CABG in addition to SAVR increases perioperative mortality [3], it remains to be seen if the addition of percutaneous coronary intervention (PCI) will worsen outcomes in patients undergoing TAVI. Current surgical guidelines continue to recommend revascularization as this strategy improves both long- and short-term survival after SAVR [4,5]. Our meta-analysis aims to determine the impact of PCI on the prognosis of patients undergoing TAVI. Electronic searches were performed using six electronic databases, using the terms “transcatheter aortic valve”, “percutaneous coronary intervention”, and “stenting” as key words or MeSH headings. Inclusion criteria included studies comparing TAVI versus TAVI + PCI approaches, with at least 10 patients in each cohort. When institutions published duplicate studies with accumulating numbers of patients or increased lengths of follow-up, only the most complete reports were included for quantitative assessment at each time interval. Abstracts, case reports, conference presentations, editorials, and expert opinions were ⁎ Corresponding author at: Cardiovascular and Thoracic Surgery, Macquarie University Hospital, Sydney, Australia; The Collaborative Research (CORE) Group, Macquarie University, 2 Technology Place, Sydney, Australia. E-mail address: [email protected] (T.D. Yan).
http://dx.doi.org/10.1016/j.ijcard.2014.11.050 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
excluded. Meta-analysis was performed by combining extracted data as pooled incidence of mortality or complications. The relative risk (RR) was used as a summary statistic for dichotomous variables, and weighted mean difference (WMD) for continuous variables. The DerSimonian– Laird random effects model was used. χ2 tests were used to study heterogeneity between trials. Five studies [2,6–9] met the inclusion criteria involving 1634 patients. Baseline characteristics are summarized in Table 1. One study used a one-stage approach [6] while two studies [8,9] performed PCI first then TAVI and two studies [2,7] looked at both staged and simultaneous procedures. Of the included patients, 1318 underwent TAVI compared with 316 patients undergoing both TAVI and PCI. There was no significant difference found between isolated TAVI and TAVI plus PCI cohorts in terms of 30-day mortality (RR, 0.80; 95% CI, 0.35–1,83; I2 = 52%; P = 0.60) (Fig. 1) with no significant heterogeneity detected. Rates of post-operative myocardial infarction between both cohorts were also comparable (RR, 0.34; 95% CI, 0.09–1.29; I2 = 21%; P = 0.11). Stroke rate was similar (RR, 1.12; 95% CI, 0.43–2.94; I2 = 0%; P = 0.81) as was the combined safety endpoint (RR, 1.18; 95% CI, 0.78–1.77; I2 = 0%; P = 0.43). Looking at the secondary outcomes (Fig. 2), rate of major bleeding was similar between both cohorts (RR, 0.85; 95% CI, 0.63–1.15; I2 = 0%; P = 0.29). The rates of major vascular access complications (RR, 0.77; 95% CI, 0.38–1.60; I2 = 0%; P = 0.49) and requirement for new pacemakers (RR, 0.88; 95% CI, 0.67–1.16; I2 = 3%; P = 0.36) are also comparable. Surprisingly, the isolated TAVI cohort had a similar rate of renal failure to those undergoing both TAVI and PCI (RR, 1.37; 95% CI, 0.90–2.10; I2 = 0%; P = 0.14). This meta-analysis suggests that performing PCI in addition to TAVI is a feasible and safe option with acceptable 30-day mortality, myocardial infarction, stroke risk and combined safety end points. This is in contrast to outcomes seen with the surgical approach in which the addition of CABG doubles peri-operative death rates from 3% in isolated SAVR to 7% in combined SAVR and CABG [3,10,11]. We did not find an increased risk of major bleeding in the cohort undergoing TAVI and PCI, despite the need for dual anti-platelet therapy in this group. There was also no increase in vascular access complications in the TAVI plus PCI group, although repeated vascular punctures had to be made. Most interestingly, we did not find a higher rate of renal failure in the patients undergoing both PCI and TAVI, despite a greater exposure to contrast medium in this group. The absence of increased rates of renal failure in the cohort undergoing multiple procedures is consistent with a recent study which showed that the amount of contrast agent delivered did not affect the risk of developing acute kidney injury after
K. Phan et al. / International Journal of Cardiology 179 (2015) 258–261
259
Table 1 Study characteristics.
Country Study period No. patients Age Male BMI (kg/m2) log EuroScore (%) Atrial fibrillation (%) Stroke/CVA (%) Peripheral artery disease (%) Prior pacemaker/ICD Prior CABG (%) Prior PCI (%) Hypertension (%) Dyslipidemia (%) Prior MI (%) LVEF (%) Aortic valve area (cm2) Peak gradient (mm Hg) Mean gradient (mm Hg)
Penkella
Griese
TAVI
TAVI
TAVI + PCI
Germany 2008–2013 517 76 80.4 83 67 72.5 27.3 26.0 ± 4.6 26.2 32.1 31.1 17.1 22.2 19.7 62 65.8 9.5 9.2 0 0 NA NA NA NA NA NA NA NA 55.5 55 0.68 0.64 ± 0.17 NA NA 48.3 47.3 ± 16.2
Germany 2009–2012 346 82 ± 5 37 NA 20.3 ± 14.6 47 10 NA NA NA 15 NA NA NA 54 ± 14 NA NA NA
Abramowitz TAVI + PCI
TAVI
65 82 ± 6 36 NA 21.7 ± 13.9 46 12 NA NA NA 15 NA NA NA 52 ± 15 NA NA NA
Israel 2009–2012 188 83 35 27.3 24.7 ± 13.8 NA 8.5 10.1 9 14.1 28.7 83.5 76.6 13.3 56.4 0.688 79 47.8
Abdel-Wahab TAVI + PCI
TAVI
61 83.6 50.8 27.2 31.3 NA 8.2 16.4 6.6 23 21.3 90.2 82 18 54.6 0.67 75.7 45.9
Germany 2007–2011 70 81 ± 6.20 49 26.40 ± 4.27 23.62 ± 15.10 NA 13 14 NA 23 33 80 60 26 48.54 ± 15.25 0.69 ± 0.21 78.54 ± 26.14 50.32 ± 16.90
± 5.5 ± 4.1 ± 13.8
± ± ± ±
9 0.14 25.4 17.2
Wenaweser TAVI + PCI
TAVI
TAVI + PCI
55 81 ± 7.06 47 27.87 ± 6.52 25.08 ± 12.58 NA 7 20 NA 15 27 84 71 26 46.92 ± 13.85 0.68 ± 0.20 77.00 ± 19.85 49.88 ± 13.74
Switzerland 2007–2010 197 81.7 ± 6.5 42.1 26.1 ± 5.0 24.2 ± 14.4 24.4 8.6 24.4 7.1 21.8 17.3 77.2 NA 15.7 51 ± 15 0.7 ± 0.2 NA 45.1 ± 16.9
59 83.6 ± 4.8 49.2 25.0 ± 4.3 26.8 ± 16.3 30.5 10.2 27.1 20.3 18.6 40.7 81.4 NA 27.1 51 ± 12 0.7 ± 0.2 NA 42.1 ± 17.3
TAVI, transcatheter aortic valve implantation; PCI, percutaneous coronary intervention; NA, not available; BMI, body mass index; CVA, cerebrovascular accident; ICD, implantable cardioverter defibrillator; CABG, coronary artery bypass graft; MI, myocardial infarction; LVEF, left ventricular ejection fraction.
TAVI [12]. First, careful patient selection might play a role in minimizing procedural complications. For instance, given the lack of randomization it is possible that only patients with a high likelihood of procedural success, such as those with easily accessible proximal lesions, were chosen for the joint PCI and TAVI strategy. Second, the duration between TAVI and PCI (where a staged strategy was chosen) might have allowed for vascular and renal healing between procedures. The results of our meta-analysis show that performing PCI in addition to TAVI does not result in a difference in short term outcomes for patients. It is important to note however that some studies have shown poorer long-term complications and mortality in the TAVI plus PCI group [7] but due to a lack of available data, we were unable to perform a meta-analysis on long-term outcomes. This meta-analysis is constrained by several limitations. There were only a small number of studies that could be included for analysis, and the small number of patients may limit statistical power. All included studies were observational and lacked randomization and propensitymatching. Only one study was prospective and four were retrospective, which introduces selection bias. There was insufficient data on longterm outcomes so this could not be evaluated. There was also heterogeneity between studies in terms of the type of stents used, vessel disease, TAVI valves and approach and anti-coagulation protocol. Different scoring systems were used to evaluate severity of CAD. In conclusion, percutaneous revascularization does not appear to affect the short-term mortality and complication rates in patients undergoing TAVI. There are a few directions we can take from here. (1) Studies are needed to establish the long-term impact of PCI on patients undergoing TAVI; (2) More data is needed to determine if there is a difference in outcomes for simultaneous versus staged procedures; (3) If staged procedures result in favorable outcomes, further studies should investigate the optimal duration allowed between TAVI and PCI procedures. Conflicts of interest The authors report no relationships that could be construed as a conflict of interest. Funding None.
Acknowledgment None. References [1] M.B. Leon, C.R. Smith, M. Mack, D.C. Miller, J.W. Moses, L.G. Svensson, et al., Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery, N. Engl. J. Med. 363 (2010) 1597–1607. [2] P. Wenaweser, T. Pilgrim, E. Guerios, S. Stortecky, C. Huber, A.A. Khattab, et al., Impact of coronary artery disease and percutaneous coronary intervention on outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation, EuroIntervention 7 (2011) 541–548. [3] F.H. Edwards, E.D. Peterson, L.P. Coombs, E.R. DeLong, W.R. Jamieson, A.L.W. Shroyer, et al., Prediction of operative mortality after valve replacement surgery, J. Am. Coll. Cardiol. 37 (2001) 885–892. [4] O. Lund, T.T. Nielsen, H.K. Pilegaard, K. Magnussen, M.A. Knudsen, The influence of coronary artery disease and bypass grafting on early and late survival after valve replacement for aortic stenosis, J. Thorac. Cardiovasc. Surg. 100 (1990) 327–337. [5] S. Windecker, P. Kolh, F. Alfonso, J.P. Collet, J. Cremer, V. Falk, et al., 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), EuroIntervention (2014), http://dx.doi.org/10.4244/EIJY14M09_01 [Epub ahead of print]. [6] A. Penkalla, M. Pasic, T. Drews, S. Buz, S. Dreysse, M. Kukucka, et al., Transcatheter aortic valve implantation combined with elective coronary artery stenting: a simultaneous approach, Eur. J. Cardiothorac. Surg. (2014), http://dx.doi.org/10.1093/ ejcts/ezu339 [Epub ahead of print]. [7] D.P. Griese, W. Reents, A. Toth, S. Kerber, A. Diegeler, J. Babin-Ebell, Concomitant coronary intervention is associated with poorer early and late clinical outcomes in selected elderly patients receiving transcatheter aortic valve implantation, Eur. J. Cardiothorac. Surg. 46 (2014) e1–e7. [8] Y. Abramowitz, S. Banai, G. Katz, A. Steinvil, Y. Arbel, O. Havakuk, et al., Comparison of early and late outcomes of TAVI alone compared to TAVI plus PCI in aortic stenosis patients with and without coronary artery disease, Catheter. Cardiovasc. Interv. 83 (2014) 649–654. [9] M. Abdel-Wahab, A.E. Mostafa, V. Geist, B. Stocker, K. Gordian, C. Merten, et al., Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention, Am. J. Cardiol. 109 (2012) 581–586. [10] S.M. O'Brien, D.M. Shahian, G. Filardo, V.A. Ferraris, C.K. Haan, J.B. Rich, et al., The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery, Ann. Thorac. Surg. 88 (2009) S23–S42. [11] D.M. Shahian, S.M. O'Brien, G. Filardo, V.A. Ferraris, C.K. Haan, J.B. Rich, et al., The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3—valve plus coronary artery bypass grafting surgery, Ann. Thorac. Surg. 88 (2009) S43–S62. [12] N. Goebel, H. Baumbach, S. Ahad, M. Voehringer, S. Hill, M. Albert, et al., Transcatheter aortic valve replacement: does kidney function affect outcome? Ann. Thorac. Surg. 96 (2013) 507–512.
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K. Phan et al. / International Journal of Cardiology 179 (2015) 258–261
Fig. 1. Forest plots of 30-day mortality, myocardial infarctions, strokes/TIA, and combined safety endpoint.
K. Phan et al. / International Journal of Cardiology 179 (2015) 258–261
Fig. 2. Forest plots of major bleeding, renal failure, major vascular access complications, and new pacemakers.
261
