BACKGROUND Severe aortic stenosis (AS) coexists with coronary artery disease (CAD) in approximately 50% of patients. The preferred treatment is combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). However, transcatheter aortic valve replacement (TAVR) along with percutaneous coronary intervention (PCI) has emerged as a viable alternative. OBJECTIVES This study sought to compare the outcomes of PCI + TAVR vs CABG + SAVR. METHODS This national multicenter retrospective study in Spain involved patients with severe AS and CAD treated between 2018 and 2021. Patients underwent either PCI + TAVR or CABG + SAVR and were compared. The primary endpoint was all-cause mortality and stroke at 1 year. Propensity score analysis was performed to mitigate baseline differences. RESULTS Of the 1,342 included patients, 625 (46.6%) underwent PCI + TAVR, and 713 (53.1%) underwent CABG + SAVR. Patients in the percutaneous arm were older (age 81.6 ± 5.8 years vs 72.1 ± 7 years; P < 0.001), had a higher prevalence of chronic kidney disease (40.6% vs 14.9%; P < 0.001), and had higher Society of Thoracic Surgeons risk scores (4.3% [interquartile range (Q1-Q3): 2.8-6.4] vs 2.2% [Q1-Q3: 1.4-3.3]; P < 0.001). Technical success rates were 96% for PCI + TAVR and 98.4% for CABG + SAVR (P = 0.008), with similar periprocedural mortality (0.8% vs 0.7%; P = 0.999). However, the mortality + stroke rate at 30 days was higher in the CABG + SAVR group compared with PCI + TAVR, both in the unmatched (12.2% vs 4.7%; P = 0.005) and matched cohorts (8.8% vs 4.5%; P = 0.002), persisting at the 1-year follow-up. CONCLUSIONS Despite a lower baseline risk, CABG + SAVR in patients with severe AS and CAD was associated with a higher rate of death and stroke compared with PCI + TAVR, highlighting the necessity for a large, randomized analysis.

中文翻译：

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冠状动脉疾病和严重主动脉瓣狭窄患者的手术与经导管治疗。


背景 大约 50% 的患者患有严重主动脉瓣狭窄 （AS） 与冠状动脉疾病 （CAD）。首选治疗方法是外科主动脉瓣置换术 （SAVR） 和冠状动脉旁路移植术 （CABG） 联合治疗。然而，经导管主动脉瓣置换术 （TAVR） 和经皮冠状动脉介入治疗 （PCI） 已成为一种可行的替代方案。目的 本研究旨在比较 PCI + TAVR 与 CABG + SAVR 的结局。方法 这项在西班牙进行的全国性多中心回顾性研究涉及 2018 年至 2021 年接受治疗的严重 AS 和 CAD 患者。患者接受 PCI + TAVR 或 CABG + SAVR 并进行比较。主要终点是 1 年全因死亡率和卒中。进行倾向评分分析以减轻基线差异。结果 在 1,342 例纳入的患者中，625 例 （46.6%） 接受了 PCI + TAVR，713 例 （53.1%） 接受了 CABG + SAVR。经皮组患者年龄较大 （年龄 81.6 ± 5.8 岁 vs 72.1 ± 7 岁;P < 0.001），慢性肾病患病率较高 （40.6% vs 14.9%;P < 0.001），并且胸外科医师协会风险评分较高 （4.3% [四分位距 （Q1-Q3）： 2.8-6.4] vs 2.2% [Q1-Q3： 1.4-3.3];P < 0.001）。PCI + TAVR 的技术成功率为 96%，CABG + SAVR 的技术成功率为 98.4% （P = 0.008），围手术期死亡率相似 （0.8% vs 0.7%;P = 0.999）。然而，与 PCI + TAVR 组相比，CABG + SAVR 组 30 天死亡率 + 卒中率更高，两者均无与伦比（12.2% 对 4.7%;P = 0.005）和匹配的队列 （8.8% 对 4.5%;P = 0.002），在 1 年随访中持续存在。 结论 尽管基线风险较低，但与 PCI + TAVR 相比，严重 AS 和 CAD 患者的 CABG + SAVR 与较高的死亡率和卒中相关，突出了进行大型随机分析的必要性。