Key result
PCI before TAVR is linked to ~148% higher mortality compared with PCI after TAVR.
Why the study?
The optimal timing to perform percutaneous coronary interventions in patients undergoing transcatheter aortic valve replacement is not well established.
Does PCI before TAVR compared to PCI after TAVR affect mortality in patients with stable CAD undergoing TAVR?
Meta-Analysis (n=1,531)
Does PCI before TAVR compared to PCI after TAVR affect mortality in patients with stable CAD undergoing TAVR?
Odds Ratio: 2.48 (95% CI 1.19–5.2)
p-value: p=0.02
In patients with stable CAD undergoing TAVR, performing PCI after TAVR rather than before is associated with lower mortality.
Post-TAVR PCI was associated with lower mortality than pre-TAVR PCI in stable CAD; leaves open optimal timing pending randomized trials.
Background: The optimal timing to perform percutaneous coronary interventions (PCIs) in patients undergoing transcatheter aortic valve replacement (TAVR) is not well established. In this meta-analysis, we aimed to compare the outcomes of patients undergoing PCI before versus after TAVR. Methods: A comprehensive literature search was performed including Medline, Embase, and Cochrane electronic databases up to 5 April 2024 for studies that compared PCI before and after TAVR reporting at least one clinical outcome of interest (PROSPERO ID: CRD42023470417). The analyzed outcomes were mortality, stroke, and myocardial infarction (MI) at follow-up. Results: A total of 3 studies involving 1531 patients (pre-TAVR PCI n = 1240; post-TAVR PCI n = 291) were included in this meta-analysis following our inclusion criteria. Mortality was higher in the pre-TAVR PCI group (OR: 2.48; 95% CI: 1.19–5.20; p = 0.02). No differences were found between PCI before and after TAVR for the risk of stroke (OR: 3.58; 95% CI: 0.70–18.15; p = 0.12) and MI (OR: 0.66; 95% CI: 0.30–1.42; p = 0.29). Conclusions: This meta-analysis showed in patients with stable CAD undergoing TAVR that PCI after TAVR is associated with lower mortality compared with PCI before TAVR.
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Caminiti et al. (2024) conducted a meta-analysis in Stable CAD undergoing TAVR (n=1,531). PCI before TAVR vs. PCI after TAVR was evaluated on Mortality (OR 2.48, 95% CI 1.19-5.20, p=0.02). In patients with stable CAD undergoing TAVR, performing PCI before TAVR was associated with higher mortality compared with PCI after TAVR (OR 2.48; 95% CI 1.19-5.20; p=0.02).
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