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Background <p>In elderly patients with severe aortic stenosis (AS), concomitant coronary artery disease (CAD) is common. Escpecially for intermediate-risk patients eligible for both interventional and surgical treatment, long-term benefit of either approach remains unclear.</p> Objectives <p>To compare long-term outcomes of TAVI + PCI versus SAVR + CABG in intermediate-risk AS-CAD patients (logistic EuroSCORE 10–20%, EuroSCORE II 4–9%).</p> Methods <p>This retrospective multicentre study included 366 patients treated between 2012 and 2020: 211 underwent TAVI + PCI and 155 received SAVR + CABG. The primary endpoint was all-cause mortality up to three years; secondary outcomes followed VARC-3 criteria.</p> Results <p>Mortality rates were similar at 30&#xa0;days (4.8% vs. 8.4%, p = 0.16), six months (12.4% each), one year (18.1% vs. 15.7%) and two years (24.9% vs. 20.1%). At three years, mortality was higher after TAVI + PCI (37.1% vs. 25.5%, <i>p</i> = 0.02), though CAD complexity was greater in the SAVR + CABG group (SYNTAX Score 22.2 vs. 15.9, <i>p</i> &lt; 0.001). TAVI + PCI patients were older (81.1 vs. 78.5&#xa0;years, <i>p</i> &lt; 0.001), but surgical risk was comparable (EuroSCORE II 6.4% vs. 6.2%). Surgical patients experienced more complications, including delirium, stroke, acute kidney injury, major bleedings and transfusion needs. After propensity score matching (154 patients per group), 3-year mortality no longer differed significantly (33.8% vs. 25.9%, p = 0.14).</p> Conclusion <p>Both TAVI + PCI and SAVR + CABG yield comparable long-term outcomes in intermediate-risk AS-CAD patients. Although early complications were more common with surgery, there was a trend towards improved long-term survival.</p> Graphical Abstract <p></p>

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TAVI plus PCI versus SAVR plus CABG: Long-term outcome of a multicentre-registry

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月11日

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  • A. Stundl,
  • L. Preuss,
  • A. Prinzing,
  • J. C. Voran,
  • H. Seoudy,
  • I. Mesanovic,
  • V. Obermeier,
  • G. Lutter,
  • M. Potratz,
  • G. Buglio,
  • A. Pohlmeyer,
  • R. Thalmann,
  • P. Hoppmann,
  • C. Bradaric,
  • H. Ruge,
  • M. Erlebach,
  • R. Lange,
  • K. L. Laugwitz,
  • T. Pühler,
  • T. Rudolph,
  • S. Bleiziffer,
  • M. Krane,
  • D. Frank,
  • C. Kupatt

摘要

Background

In elderly patients with severe aortic stenosis (AS), concomitant coronary artery disease (CAD) is common. Escpecially for intermediate-risk patients eligible for both interventional and surgical treatment, long-term benefit of either approach remains unclear.

Objectives

To compare long-term outcomes of TAVI + PCI versus SAVR + CABG in intermediate-risk AS-CAD patients (logistic EuroSCORE 10–20%, EuroSCORE II 4–9%).

Methods

This retrospective multicentre study included 366 patients treated between 2012 and 2020: 211 underwent TAVI + PCI and 155 received SAVR + CABG. The primary endpoint was all-cause mortality up to three years; secondary outcomes followed VARC-3 criteria.

Results

Mortality rates were similar at 30 days (4.8% vs. 8.4%, p = 0.16), six months (12.4% each), one year (18.1% vs. 15.7%) and two years (24.9% vs. 20.1%). At three years, mortality was higher after TAVI + PCI (37.1% vs. 25.5%, p = 0.02), though CAD complexity was greater in the SAVR + CABG group (SYNTAX Score 22.2 vs. 15.9, p < 0.001). TAVI + PCI patients were older (81.1 vs. 78.5 years, p < 0.001), but surgical risk was comparable (EuroSCORE II 6.4% vs. 6.2%). Surgical patients experienced more complications, including delirium, stroke, acute kidney injury, major bleedings and transfusion needs. After propensity score matching (154 patients per group), 3-year mortality no longer differed significantly (33.8% vs. 25.9%, p = 0.14).

Conclusion

Both TAVI + PCI and SAVR + CABG yield comparable long-term outcomes in intermediate-risk AS-CAD patients. Although early complications were more common with surgery, there was a trend towards improved long-term survival.

Graphical Abstract