TY - JOUR
T1 - Percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation
T2 - a systematic review and meta-analysis
AU - Aarts, Hugo M.
AU - van Hemert, Nicole D.
AU - Meijs, Timion A.
AU - van Nieuwkerk, Astrid C.
AU - Berg, Jurriën M.ten
AU - Wykrzykowska, Joanna J.
AU - van Royen, Niels
AU - Schotborgh, Carl E.
AU - Tonino, Pim A.L.
AU - IJsselmuiden, Alexander
AU - Vossenberg, Tessel N.
AU - van Houwelingen, Gert K.
AU - Slagboom, Ton
AU - Voskuil, Michiel
AU - Delewi, Ronak
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - 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.
AB - 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.
KW - Aortic Valve Stenosis
KW - Coronary Artery Disease
KW - Percutaneous Coronary Intervention
KW - Transcatheter Aortic Valve Implantation
UR - http://www.scopus.com/inward/record.url?scp=85175376919&partnerID=8YFLogxK
U2 - 10.1007/s12471-023-01824-w
DO - 10.1007/s12471-023-01824-w
M3 - Article
AN - SCOPUS:85175376919
SN - 1568-5888
VL - 31
SP - 489
EP - 499
JO - Netherlands Heart Journal
JF - Netherlands Heart Journal
IS - 12
ER -