Post-TAVI PCI was associated with significantly lower all-cause mortality versus pre-TAVI PCI (OR 2.11) and concurrent PCI (OR 1.50) in severe AS with CAD patients.
Does staged post-TAVI PCI reduce all-cause mortality compared to pre-TAVI or concurrent PCI in patients with severe aortic stenosis and coronary artery disease undergoing TAVI?
In patients with severe aortic stenosis and coronary artery disease, deferring PCI until after TAVI may be associated with a lower risk of mortality compared to pre-TAVI or concurrent PCI.
Absolute Event Rate: 0% vs 0%
Abstract Background Although patients with severe aortic stenosis (AS) often also have significant concomitant coronary artery disease (CAD), the optimal timing of percutaneous coronary intervention (PCI) in relation to transcatheter aortic valve implantation (TAVI) remains uncertain. Purpose This meta-analysis evaluates the association of pre-TAVI PCI, concurrent PCI at the time of TAVI, and post-TAVI PCI on risk of all-cause mortality. Methods A literature search was conducted using the databases Pubmed, Embase, and Web of Science, looking for studies that evaluated the association of different timing of PCI with risk of the primary endpoint, all-cause mortality, in patients with CAD and severe AS undergoing TAVI. The search was not restricted by time or publication status. Results A total of 8 studies including 8,506 patients met the inclusion criteria. Patients were categorized into three groups: pre-TAVI PCI (n=2,323), concurrent PCI at TAVI (n=1,635), and staged post-TAVI PCI (n=4,548). The mean follow-up duration was 10.5 months, the mean age was 81 years, and 55% of the cohort were men. Compared to both pre-TAVI PCI and concurrent PCI strategies, post-TAVI PCI was associated with a significantly lower risk of all-cause mortality on follow-up in patients with CAD and severe AS (OR 2.11, 95% CI 1.41-3.17; p0.01; OR 1.50, 95% CI 1.0-2.23; p=0.05). There was no significant difference in risk of all-cause mortality between pre-TAVI PCI and concurrent PCI at the time of TAVI (OR 0.95, 95% CI 0.77-1.19; p=0.68). Conclusion Based on the findings from this meta-analysis, deferring PCI until after TAVI may be associated with lower risk of mortality compared to performing PCI prior to or at the time of TAVI. However, additional high quality studies are needed to further establish these findings and to optimize the revascularization strategies for this patient population.Figure 1
Gupta et al. (Sat,) reported a other. Post-TAVI PCI was associated with significantly lower all-cause mortality versus pre-TAVI PCI (OR 2.11) and concurrent PCI (OR 1.50) in severe AS with CAD patients.
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