Assessing the impact of age on outcomes following percutaneous coronary intervention in patients undergoing transcatheter aortic valve replacement - a substudy in NOTION-3

Abstract Background Findings from the recent NOTION-3 trial suggest that percutaneous coronary intervention (PCI) improves outcomes in patients with severe aortic stenosis and concomitant coronary artery disease undergoing transcatheter aortic valve implantation (TAVI). Whether the benefit of PCI is consistent across age groups is uncertain. Aims To investigate the impact of age on outcomes from NOTION-3. Methods A secondary analysis of 455 patients in the NOTION-3 trial, a randomised trial comparing PCI with conservative treatment in patients with aortic stenosis and coronary artery disease undergoing TAVI. Patients were stratified into four age groups based on the quartile distribution of age (<78, 78-81, 82-84 and ≥85 years) and followed for a median of 2 years (IQR: 1–4 years). The primary outcome was major adverse cardiac events (MACE) defined as a composite of all-cause death, myocardial infarction, or urgent revascularisation. Results The risk difference for the primary endpoint comparing PCI and conservative treatment was most pronounced in patients aged 78-81 years (17% vs 42%; HR: 0.36, 95% CI: 0.17-0.77, p = 0.008). For the age groups <75, 82-84 and ≥85 years this risk difference between treatment groups was (HR: 1.08, 95% CI: 0.48-2.40), (HR: 0.69, 95% CI: 0.35-1.35) and (HR: 0.90, 95% CI: 0.50-1.62), respectively. Conclusion In patients with coronary artery disease undergoing TAVI the benefit of PCI compared with conservative treatment on the composite of all-cause death, myocardial infarction, or urgent revascularisation was most pronounced among patients aged 78-84 years.