Safety of PCI in patients with coronary artery disease and aortic stenosis undergoing TAVI

Abstract Background Coronary artery disease (CAD) is a frequent coexisting issue in patients with severe aortic stenosis (AS). While professional societies have recommended complete revascularization in patients undergoing surgical aortic valve implantation, the safety and efficacy of percutaneous coronary intervention (PCI) in patients with CAD and severe AS who are undergoing transcatheter aortic valve implantation (TAVI) remains unclear. Purpose In this study, we performed a systematic review and meta-analysis evaluating the safety of PCI in patients with CAD and severe AS who are undergoing TAVI. Methods We performed a literature search using the databases Pubmed, Embase, and Web of Science, looking for studies that evaluated the association between PCI and safety outcomes in patients with CAD and severe AS undergoing TAVI. The endpoints of interest were risk of device-related vascular complications, major bleeding, minor bleeding, renal failure, and cerebrovascular accident (CVA) or transient ischemic attack (TIA). The search was not limited by time or publication status. Results A total of 11 studies with 6,758 patients with CAD and severe AS who were undergoing TAVI met inclusion criteria. 1,842 patients received PCI while 4,916 patients did not receive PCI. The mean follow-up duration was 4.4 months (ranging 1 month to 24 months), mean age was 82.1 years old, 49.2% were men, the mean aortic valve area was 0.7, mean aortic valve gradient was 45 mmHg, mean left ventricular ejection fraction was 53.6%. There was a statistically significantly higher risk of device-related vascular complications in patients who received PCI compared to patients who did not receive PCI (OR 1.97, 95% CI 1.47, 2.62; p0.01). The heterogeneity for this analysis was low (I2 = 0%). There was no statistically significant difference in risk of major bleeding, minor bleeding, renal failure, or CVA/TIA between patients who did or did not receive PCI (OR 1.17, 95% CI 0.81, 1.7; p=0.41; OR 1.3, 95% CI 0.91, 1.86; p=0.15; OR 0.65, 95% CI 0.37, 1.16; p=0.14; OR 0.74, 95% CI 0.49, 1.12; p=0.16). Conclusions In patients with both CAD and severe AS who are undergoing TAVI, PCI is associated with significantly higher risk of device-related vascular complications but no difference in risk of major/minor bleeding, renal failure, or CVA/TIA. Given the potential risks for adverse events shown in this study, additional high-quality studies are needed to better establish the clinical benefit of performing PCI in this patient population.Figure 1 Figure 2