Key result
Concomitant PCI and TAVR shows no difference in 30-day mortality versus staged procedures.
Why the study?
Significant coronary artery disease is common in patients undergoing TAVR, but the optimal timing of PCI relative to TAVR is controversial.
Does concomitant PCI and TAVR improve short-term mortality and safety outcomes compared to staged PCI and TAVR in patients with severe aortic stenosis and coronary artery disease?
Systematic Review (n=209)
Does concomitant PCI and TAVR improve short-term mortality and safety outcomes compared to staged PCI and TAVR in patients with severe aortic stenosis and coronary artery disease?
Concomitant PCI and TAVR appears to have similar short-term safety and mortality outcomes compared to a staged approach, suggesting both are viable strategies.
Answers are grounded in this paper and cite their sources.
Similar short-term outcomes support equipoise between concomitant and staged PCI with TAVR; leaves open optimal timing pending randomized trials.
BACKGROUND: TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Significant coronary artery disease (CAD) is present in 40% to 75% of patients undergoing TAVR. However, when to treat the concomitant coronary artery lesions is controversial. METHODS: This is a systematic review comparing concomitant PCI and TAVR versus staged PCI and TAVR. The OVID database was systematically searched for studies reporting PCI in patients undergoing TAVR. A random effects model was used to calculate the pooled odds ratio (OR) with 95% confidence intervals. RESULTS: Four observational studies and a total of 209 patients were included in this analysis. Overall 30-day mortality was similar between concomitant PCI and TAVR versus staged PCI and TAVR [OR: 1.47 (0.47-4.62); P = .51], renal failure was not significantly different between both groups [OR: 3.22 (0.61-17.12); P = .17], periprocedural myocardial infarction was not different between the 2 groups [OR: 1.44 (0.12-16.94); P = .77], life-threatening bleeding did not differ between both groups [OR: 0.45 (0.11-1.87); P = .27], and major stroke also was not significantly different [OR: 3.41 (0.16-74.2); P = .44]. CONCLUSION: These data did not show a significant difference in short-term outcomes between concomitant PCI and TAVR versus staged PCI and TAVR.
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Yang et al. (2017) conducted a systematic review in Severe aortic valve stenosis and coronary artery disease (n=209). Concomitant PCI and TAVR vs. Staged PCI and TAVR was evaluated on 30-day mortality (OR 1.47, 95% CI 0.47-4.62, p=.51). Concomitant PCI and TAVR showed no significant difference in 30-day mortality compared to staged PCI and TAVR.
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