Why the study?
The optimal management and timing of percutaneous coronary intervention in patients with coronary artery disease undergoing transcatheter aortic valve implantation remains uncertain.
Does combined pre-TAVI and concomitant PCI compared to post-TAVI PCI affect mortality in patients with severe aortic stenosis and coronary artery disease undergoing TAVI?
Meta-Analysis (n=15,412)
Does combined pre-TAVI and concomitant PCI compared to post-TAVI PCI affect mortality in patients with severe aortic stenosis and coronary artery disease undergoing TAVI?
Odds Ratio: 5.7 (95% CI 1.34–24.36)
In patients undergoing TAVI, combined pre-TAVI and concomitant PCI is associated with higher 30-day and 2-year mortality compared to post-TAVI PCI, though high-quality randomized data are lacking.
May warrant preferring post-TAVI PCI to lower 30-day mortality; leaves open optimal timing pending randomized trials.
Background: Transcatheter aortic valve implantation (TAVI) is widely performed for severe aortic stenosis (AS), often accompanied by coronary artery disease (CAD). The optimal management of CAD in TAVI patients remains uncertain. This study reviews the evidence on percutaneous coronary intervention (PCI) timing in TAVI, and proposes an algorithmic approach for CAD management. Methods: A comprehensive search of PubMed, EMBASE and Cochrane identified studies comparing PCI timing strategies in TAVI patients. Results: Thirteen studies with 15,412 participants were included. Mortality at 30 days (OR 5.70; 95% CI [1.34-24.36]) and 2 years (OR 4.40; 95% CI [2.60-7.44]) were significantly higher in the combined pre-TAVI and concomitant PCI group than in the post-TAVI cohort. Rates of other periprocedural complications, such as stroke and bleeding, varied across studies. Conclusion: There is no clear consensus on PCI timing in TAVI due to a lack of high-quality randomised data. An individualised, algorithmic approach is proposed for managing CAD in patients undergoing TAVI.
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Murray et al. (2025) conducted a meta-analysis in Severe aortic stenosis with coronary artery disease (n=15,412). Combined pre-TAVI and concomitant PCI vs. Post-TAVI PCI was evaluated on Mortality at 30 days (OR 5.70, 95% CI 1.34-24.36).
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