Percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Abstract

Objective The importance of revascularisation of significant coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is unclear. Despite the lack of randomised controlled trials comparing different revascularisation strategies, guidelines currently recommend percutaneous coronary intervention (PCI) in patients with significant proximal CAD undergoing TAVI. Methods In this systematic review and meta-analysis, a systematic search was conducted to identify studies comparing TAVI with and without PCI in patients with significant CAD on pre-TAVI coronary angiography. Endpoints were all-cause mortality, cardiac death, stroke, myocardial infarction and major bleeding. Results In total, 14 studies were included, involving 3838 patients, of whom 1806 (47%) underwent PCI before TAVI. All-cause mortality did not differ significantly between TAVI with and without preceding PCI at 30 days, 1 year and > 1 year. There were no significant differences in risk of cardiac death, stroke or myocardial infarction between the groups. However, TAVI performed with PCI resulted in a higher risk of major bleeding within 30 days after TAVI (odds ratio: 0.66; 95% confidence interval: 0.46–0.94). Conclusion This systematic review and meta-analysis showed no significant differences in clinical outcomes between patients with concomitant significant CAD who were treated with TAVI with and without preceding PCI at both short- and long-term follow-up. However, there was a higher risk of major bleeding at 30 days in patients undergoing TAVI with preceding PCI. In the context of serious risk of bias in the included studies, results of randomised controlled trials are warranted.

Concomitant percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation

“…30 Moreover, a large multicenter registry evaluating complete or incomplete coronary revascularisation in patients with stable CAD found no difference in short-term outcomes when comparing different PCI timing strategies. 32 The present study is one of the largest analyses 33 with the longest follow-up time and the only one so far, evaluating coPCI in TAVI patients according to the VARC-3 endpoints.…”

“…The present study is one of the largest analyses 33 with the longest follow‐up time and the only one so far, evaluating coPCI in TAVI patients according to the VARC‐3 endpoints.…”

Percutaneous coronary intervention timing and coronary physiology in transcatheter aortic valve implantation patients

“…We read with great interest the systematic review and meta-analysis by Aarts et al. [ 1 ]. We would like to congratulate the authors.…”

“…We would like to congratulate the authors. The current meta-analysis shows that there is no clear benefit of performing percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve implantation (TAVI) when looking at hard endpoints, mostly at 30 days and 1 year [ 1 ]. Sometimes, however, it is presumed that longer-term follow-up is necessary to see any prognostic benefit—potentially in combination with complete revascularisation.…”

Reply to ‘Percutaneous coronary intervention timing and coronary physiology in transcatheter aortic valve implantation patients’

“…We thank Dr. Minten and colleagues for their interest and thorough review of our manuscript on the importance of preprocedural revascularisation in patients undergoing transcatheter aortic valve implantation (TAVI) [ 1 ]. The authors emphasise that further research is warranted to elucidate the role of percutaneous coronary intervention (PCI) in these patients, including the ideal timing of PCI, coronary physiology and the possible benefit regarding long-term outcomes.…”