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In patients with stable coronary artery disease (CAD) and severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVI), the addition of PCI to the treatment strategy was associated with a reduction in major cardiovascular AEs (MACE) as compared with TAVI plus conservative treatment. Since these two conditions often co-exist, these findings may help to improve the clinical outcomes for a large group of patients.
“TAVI and PCI are performed simultaneously in about 15% of patients undergoing TAVI for severe aortic stenosis,” according to Dr. Jacob Lønborg, MD, PhD, DMSc, from Copenhagen University Hospital, in Denmark. “There is, however, no evidence from clinical trials to support this strategy.” Thus, the aim of the NOTION-3 study (NCT03058627) was to test the hypothesis that routine revascularization with PCI in addition to TAVI will improve clinical outcomes in patients with stable CAD and severe aortic stenosis compared with TAVI plus conservative management. The 455 participants were randomly assigned 1:1 to TAVI plus conservative management or TAVI plus PCI. The primary endpoint was MACE from 1 to 5 years of follow-up.
After a median of 2 years of follow-up, TAVI plus PCI performed better with respect to MACE than TAVI alone, with event rates of 26% and 36%, respectively (HR 0.71; 95% CI 0.51–0.99; P=0.04). Looking at individual components of MACE, the authors observed no statistically significant difference between the 2 study arms regarding all-cause mortality (23% vs 27%; HR 0.85; 95% CI 0.59–1.23) but did report improved outcomes in the PCI arm for myocardial infarction (7% vs 14%; HR 0.54; 95% CI 0.30–0.97), and urgent revascularization (2% vs 11%; HR 0.20; 95% CI 0.08–0.51).
“Based on the results of our study, adding PCI to TAVI appears to be a solid strategy to treat patients with severe aortic stenosis and stable CAD,” concluded Dr. Lønborg.
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