Abstract 4138788: Outcomes of Percutaneous Coronary Interventions Following Transcatheter Aortic Valve Replacement: Insights from the National Cardiovascular Data Registry (NCDR) CathPCI Registry

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Background: Although transcatheter aortic valve replacement (TAVR) devices can impair coronary access, there are limited real-world data on rates of percutaneous coronary intervention (PCI) and PCI outcomes in post-TAVR patients. Research Question: How often do patients who undergo TAVR develop coronary events, and do they have different procedural characteristics or rates of adverse events when undergoing PCI compared to patients without a TAVR? Methods: We used CMS claims data for the Medicare fee-for-service population to evaluate the incidence of PCI after TAVR between 2011-2017. Then, using data from the NCDR CathPCI Registry linked with Medicare claims, we compared procedural characteristics and PCI outcomes between patients with a history of TAVR vs. propensity-matched patients who did not have a history of TAVR. Results: Of the 52,780 Medicare fee-for-service patients who underwent TAVR between 2011-2017, the incidence of acute myocardial infarction (AMI) was 10.6% and of PCI was 5.4% at five years. Among those patients, 5.6% had a PCI in the three months preceding their TAVR. After propensity-score matching, the procedural success rates for PCI were similar between patients with vs. without a history of TAVR. However, in the propensity-matched comparison, PCI in post-TAVR patients required greater fluoroscopic time (21.9 vs 17.7 mins, p<0.001) and was associated with a greater incidence of post-procedural stroke (0.8% vs 0.4%, p=0.02) and bleeding (5.1% vs 2.9%, p < 0.001). At three-year follow-up post-PCI, there were no differences in the rates of AMI between patients with vs. without a history of TAVR (HR: 1.22, 95% C.I.: 0.97, 1.54, p=0.08). However, patients with prior TAVR were more likely to have repeat PCI in the three years following their index procedure (HR: 1.38, 95% C.I.: 1.12, 1.73, p=0.003). Conclusion: Among Medicare fee-for-service patients, one in 20 patients undergoing TAVR subsequently underwent PCI within 5 years. Although the rates of procedural success were similar, patients with a history of TAVR who underwent PCI had longer fluoroscopic times, more frequent in-hospital adverse events, and a higher likelihood of a repeat PCI compared with matched patients without a history of TAVR.