Abstract 17383: Comparative Analysis of TAVR With PCI and SAVR With CABG - A Nationwide Inpatient Sample Database

Abstract

Introduction: For patients with coronary artery disease (CAD) and severe aortic stenosis (AS), the relative safety of percutaneous approach [transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI)] to surgical approach [SAVR and coronary artery bypass graft (CABG)] has not been studied. Hypothesis: TAVR+PCI carries a higher risk of complications. Methods: The National Inpatient Sample (NIS) from 2002-2014 was queried to identify all cases of TAVR+PCI and SAVR+CABG. Univariate and multiple logistic regression analyses were used to control the outcomes. Results: A total of 215829 (TAVR+PCI 1634, SAVR+CABG 214195) patients were included. The unadjusted odds for in-hospital mortality (5.6% vs. 9.5%, uOR 0.57;95% CI, 0.48-0.67, p=<0.001), acute kidney injury (18.9% vs. 26.3%, uOR 0.65; 95% CI, 0.59-0.73, P = 0.001), major bleeding (12.3% vs. 18.6%, uOR 0.61; 95% CI, 0.53-0.69, P = <0.001), vascular complications (2.2% vs. 10.7%, uOR 0.19; 95% CI, 0.16-0.22, P = <0.001), cardiogenic shock (4.5% vs. 8.6%, uOR 0.51; 95% CI, 0.16-0.22, P = <0.001) and septic shock (1% vs. 1.8%, uOR 0.54; 95% CI, 0.38-0.79, P <0.002), were significantly lower in patients undergoing SAVR+CABG compared to TAVR with PCI, respectively. The adjusted odds ratio based on baseline comorbidities, demographic and age closely mirrored the unadjusted odds ratios. Conclusions: In patients with the concomitant severe aortic disease and coronary artery disease, TAVR with PCI might have higher odds of in-hospital complications and mortality compared to SAVR+CABG. The mean hospital charges were also lower with the open surgical approach.