Abstract 12407: Method of Coronary Revascularization Has No Prognostic Impact on Most Transcatheter Aortic Valve Implantation (TAVI) Outcomes.

Background: Patients with both aortic stenosis and coronary artery disease who are candidates for TAVI pose considerable management challenges. We evaluated whether the method of coronary revascularization mode, by percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG), impacted post-TAVI outcomes. Methods: The National Inpatient Sample database (NIS) was sampled, and 13,265 patients who underwent TAVI from 2011-2014 with history of either PCI or CABG comprised the study group; unrevascularized CAD, or history of both CABG and PCI, were exclusions. In-hospital outcomes between the two methods (PCI vs CABG) were compared, including myocardial infarction (MI), cardiogenic shock, stroke, and in-hospital mortality. Results: Overall, 66.2% of the study group were males. In-hospital mortality was not significantly different between PCI and CABG groups, 2.8% and 2.5%, respectively (p=0.251). Both PCI and CABG groups had similar stroke rates (each 2.2%). 2.2% of PCI patients had post-TAVI MI in comparison to 2.4% CABG (p=0.407). Cardiogenic shock occurred in 2.6% of CABG and 1.7% of PCI patients (p=0.001); multivariate logistic regression showed that CABG was independently associated with increased risk for cardiogenic shock (adjusted OR:1.452; CI: 1.113 - 1.894; p=0.006) Neither PCI nor CABG had a significant association with any of the other clinical outcomes. Conclusion: The method of coronary revascularization had no significant impact on post TAVI in-hospital outcomes. Patients with prior CABG merit particular caution during TAVI and avoidance of hypotension, as they are more likely to develop cardiogenic shock. [ABSTRACT FROM AUTHOR]