The value of percutaneous coronary intervention in aortic valve stenosis with coronary artery disease

OBJECTIVES: The study determines whether treatment of coronary disease by percutaneous coronary intervention (PCI) in the presence of severe aortic stenosis (AS) is feasible and defines which patients might benefit most. BACKGROUND: Severe symptomatic AS is considered a class I indication for aortic valve replacement (AVR). Many patients with AS have concomitant coronary artery disease (CAD), and the true reason for symptoms is often unclear. It is common practice to combine AVR with coronary artery bypass grafting. However, in some cases PCI alone might improve symptoms and allow surgery to be deferred. METHODS: We analyzed 38 consecutive patients who underwent PCI for CAD in the presence of significant AS between 1989 and 2004. Data included demographic factors, clinical features, angiographic, and echocardiographic information. Events during follow-up included PCI complications, improvement post- PCI, AVR, and death. Statistical analysis was used to assess the impact of PCI on outcome and survival. RESULTS: The mean age of the study group was 71 +/- 9.3 years, and the mean aortic valve area was 0.84 +/- 0.28 (0.4-1.2) cm(2). Reasons for choosing PCI over surgery were patients' preference, high surgical risk, and cardiologist recommendation. Thirty-five patients (92.1%) reported symptomatic improvement after PCI, and no major PCI-related complications were recorded. Significant predictors for long-term event-free survival were good functional class (P = .006) and single-vessel coronary disease (P = .017). CONCLUSION: PCI in patients with severe AS and significant CAD is safe, offers relief of symptoms in most cases, and has good long-term outcome in a subset of patients who have mild CAD and good functional class. This therapeutic approach should be considered in such patients and in those with high surgical risk. (c) 2007 Elsevier Inc. All rights reserved.