Role of PCI in CAD associated with severe aortic stenosis

Conventionally CAD (coronary artery disease) associated with severe aortic stenosis is an indication for coronary artery bypass grafting along with surgical aortic valve replacement. But in this era of transcatheter aortic valve replacement (TAVR; also known as transcatheter aortic valve implantation or TAVI), is there a role of PCI (percutaneous coronary intervention) in those awaiting TAVR? Goel SS and colleagues evaluated this aspect in a retrospective analysis of their PCI database [Percutaneous coronary intervention in patients with severe aortic stenosis: implications for transcatheter aortic valve replacement. Circulation. 2012 Feb 28;125(8):1005-13]. They could identify over two hundred and fifty patients with severe aortic stenosis who had undergone PCI for their associated CAD. They also identified over five hundred patients without aortic stenosis who had undergone PCI using propensity matching. The investigators concluded that percutaneous coronary intervention could be performed in those with severe symptomatic aortic stenosis and CAD with no significant increased risk of short term mortality compared to propensity matched patients without significant aortic stenosis. They also observed that patients with severe left ventricular dysfunction (ejection fraction thirty percent or less) and those with STS (Society of Thoracic Surgeons) score of 10 percent or more are at a highest risk of 30 day mortality after PCI. Online STS risk calculator is available at: http://riskcalc.sts.org/STSWebRiskCalc273/

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