1
|
GAROT P, Morice MC, Angiolillo DJ, Cabau JR, Park DW, Van Mieghem NM, Collet JP, Leon MB, Sengottuvelu G, Neylon A, ten Berg JM, Mylotte D, Tchétché D, Krucoff MW, Reardon MJ, Piazza N, Mack MJ, Généreux P, Makkar R, Hayashida K, Ohno Y, Mochizuki S, Shirai Y, Matsumara R, Jin Y, Webb JG, Cutlip DE, Chen M, Spitzer E, Mehran R, Capodanno D. Defining high bleeding risk in patients undergoing transcatheter aortic valve implantation: a VARC-HBR consensus document. EUROINTERVENTION 2024; 20:536-550. [PMID: 38726720 PMCID: PMC11067726 DOI: 10.4244/eij-d-23-01020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/12/2024] [Indexed: 05/14/2024]
Abstract
The identification and management of patients at high bleeding risk (HBR) undergoing transcatheter aortic valve implantation (TAVI) are of major importance, but the lack of standardised definitions is challenging for trial design, data interpretation, and clinical decision-making. The Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) is a collaboration among leading research organisations, regulatory authorities, and physician-scientists from Europe, the USA, and Asia, with a major focus on TAVI-related bleeding. VARC-HBR is an initiative of the CERC (Cardiovascular European Research Center), aiming to develop a consensus definition of TAVI patients at HBR, based on a systematic review of the available evidence, to provide consistency for future clinical trials, clinical decision-making, and regulatory review. This document represents the first pragmatic approach to a consistent definition of HBR evaluating the safety and effectiveness of procedures, devices and drug regimens for patients undergoing TAVI..
Collapse
Affiliation(s)
- Philippe GAROT
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital privé Jacques Cartier, Ramsay-Santé, Massy, France
- Cardiovascular European Research Center (CERC), Massy, France
| | - Marie-Claude Morice
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital privé Jacques Cartier, Ramsay-Santé, Massy, France
- Cardiovascular European Research Center (CERC), Massy, France
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Josep Rodés- Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
- Clínic Barcelona, Barcelona, Spain
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Nicolas M. Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, the Netherlands
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital, Paris, France
| | - Martin B. Leon
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA and Cardiovascular Research Foundation, New York, NY, USA
| | - Gunasekaran Sengottuvelu
- Department of Cardiology, Apollo Hospitals, Chennai, Tamil Nadu, India
- Department of Cardiology and Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Antoinette Neylon
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital privé Jacques Cartier, Ramsay-Santé, Massy, France
- Cardiovascular European Research Center (CERC), Massy, France
| | | | - Darren Mylotte
- Galway University Hospital and University of Galway, Galway, Ireland
| | - Didier Tchétché
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Mitchell W. Krucoff
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Nicolo Piazza
- McGill University Health Centre, Montreal, QC, Canada
| | | | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | | | | | | | - Yu Jin
- Notified body 1639, SGS, Antwerp, Belgium
| | - John G. Webb
- Department of Cardiology, St. Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Donald E. Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA and Baim Clinical Research Institute, Boston, MA, USA
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Center, and Cardialysis, Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Davide Capodanno
- Cardiovascular European Research Center (CERC), Massy, France
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, Italy
| |
Collapse
|
2
|
Rheude T, Costa G, Ribichini FL, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Ribeiro HB, Saia F, Bunc M, Tchétché D, Garot P, Mylotte D, Burzotta F, Watanabe Y, Bedogni F, Tesorio T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Xhepa E, Kargoli F, Tamburino C, Joner M, Barbanti M. Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2023; 19:589-599. [PMID: 37436190 PMCID: PMC10495747 DOI: 10.4244/eij-d-23-00186] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown. AIMS We sought to compare different PCI timing strategies in TAVI patients. METHODS The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method. RESULTS A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days. CONCLUSIONS In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.
Collapse
Affiliation(s)
- Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ignacio J Amat Santos
- CIBERCV, Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Matjaz Bunc
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Philippe Garot
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | | | - Francesco Burzotta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Tullio Tesorio
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | | | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Italo Porto
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Caterina Gandolfo
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda ospedaliera-universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Alessandro S Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | - Luigi Biasco
- Azienda Sanitaria Locale di Ciriè, Chivasso e Ivrea, ASL TO4, Ivrea, Italy
| | | | - Marco Zimarino
- Department of Cardiology, SS. Annunziata Hospital Chieti, ASL 2 Abruzzo, Chieti, Italy and Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | | | | | - Alexandre Gautier
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Galway University Hospital, Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Vincenzo De Marzo
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Elisa Piredda
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Stefano Cannata
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | | | | | | | | | | | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Erion Xhepa
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Michael Joner
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
- Università degli Studi di Enna "Kore", Enna, Italy
| |
Collapse
|