The need for future coronary access in older medicare beneficiaries following transcatheter aortic-valve replacement

BackgroundWhile approximately 17% of patients less than 80 years old require coronary access in the 7 years following their TAVR, the need for coronary access among older TAVR patients is unknown. Methods: We examined the percentage of Medicare beneficiaries aged 80-90 years that require coronary access [percutaneous coronary intervention (PCI) or angiogram] in the 8 years following their TAVR using data from the Medicare 5% Standard Analytic File (2011-2021). The need for coronary access in older patients was estimated for all TAVRs, TAVR patients with and without a history of PCI, and TAVR patients with and without coronary artery disease (CAD) using time-to-event models adjusted for age, sex, race, region, ECI score, concomitant CABG, CAD, PCI, and current or recent smoker status. Multivariate log-gamma regressions were used to estimate the total cost of hospitalizations requiring coronary access post-TAVR. Results: A total of 6845 patients met inclusion criteria. The incidence rates for undergoing PCI or angiogram at 1, 3, 5, and 8 years were 1.9%, 4.0%, 5.5%, and 6.3%, respectively. TAVR patients with PCI demonstrated higher rates of coronary intervention compared to those without PCI (10.2% vs. 6.2% at 8 years, respectively). Similarly, TAVR patients with a prior CAD diagnosis exhibited increased rates of coronary intervention compared to those without a prior CAD diagnosis (7.4% vs. 2.1% at 8 years, respectively). The mean adjusted cost of hospitalizations requiring coronary access was $30,170 [95% Confidence Interval: $27,865-$32,665]. Conclusions: Approximately 6.8% of older TAVR patients require coronary access in the 8 years following their index procedure. The presence of a prior PCI or CAD diagnosis is associated with an increased requirement for subsequent coronary access.