Abstract
Although transcatheter aortic valve replacement (TAVR) devices can impair coronary access, there are limited real-world data comparing outcomes of percutaneous coronary intervention (PCI) in post-TAVR vs. non-TAVR patients. In this study, we compare procedural characteristics and outcomes between patients with vs. without a history of TAVR who undergo PCI. We used claims data for the Medicare population to evaluate the incidence of PCI after TAVR between 2011-2017. Then, using the CathPCI Registry, we compared PCI outcomes between patients with a history of TAVR vs. propensity score-matched non-TAVR patients. Of the 52,780 Medicare patients who underwent TAVR between 2011-2017, the incidence of acute myocardial infarction (AMI) was 10.2% and of PCI was 5.1% at 5 years. At five years, the incidence of stroke was 5.0% and of death was 64.0%. In the CathPCI Registry, procedural success for PCI was similar between 1,309 post-TAVR patients vs. 5,236 propensity-score matched patients without prior TAVR. However, post-TAVR patients required greater fluoroscopic time (21.9 vs 17.7 mins, p<0.001) and had higher rates of post-procedural stroke (0.8% vs 0.4%, p=0.02) and bleeding (5.1% vs 2.9%, p<0.001). Post-TAVR patients were more likely to have repeat PCI in the 3 years post-PCI (HR: 1.36, 95% C.I: 1.09, 1.70) and had higher rates of stroke (HR: 1.65, C.I.: 1.07-2.56, p=0.023) and death (HR: 1.23, C.I.: 1.11-1.38, p<0.001) compared to non-TAVR patients. In conclusion, in the CathPCI Registry, patients with a history of TAVR appeared to have similar procedural success but longer fluoroscopic times, more frequent post-procedural bleeding and stroke, and a higher likelihood of a repeat PCI compared with matched patients without a history of TAVR.