Key result
PCI before or with TAVI increases long-term all-cause mortality ~20% versus TAVI alone.
Why the study?
The clinical benefits of different PCI timing strategies in patients undergoing TAVI with concomitant CAD remain unclear.
Does PCI before or concomitant with TAVI reduce all-cause mortality compared to TAVI alone or PCI after TAVI in patients undergoing TAVI with coexisting CAD?
Meta-Analysis (n=15,812)
Yes
Does PCI before or concomitant with TAVI reduce all-cause mortality compared to TAVI alone or PCI after TAVI in patients undergoing TAVI with coexisting CAD?
Relative Risk: 1.2 (95% CI 1.06–1.36)
p-value: p=0.005
In patients undergoing TAVI with concomitant CAD, performing PCI after TAVI is associated with improved clinical outcomes compared to performing PCI before or during TAVI.
May support deferring PCI until after TAVI in CAD patients; leaves open need for RCTs to confirm.
The aim of this study is to compare the clinical benefits associated with different percutaneous coronary intervention (PCI) timing strategies in patients undergoing transcatheter aortic valve implantation (TAVI) who have coexisting coronary artery disease (CAD). A systematic review and meta-analysis were conducted. PubMed, EMBASE, Cochrane Library and Web of Science databases were searched for relevant articles up to April 10th, 2024. Studies that reported comparisons of clinical outcomes between PCI before/concomitant with TAVI (PCI-TAVI) vs. TAVI alone, or comparisons between PCI before/concomitant with TAVI vs. PCI after TAVI (TAVI-PCI) were selected. Primary outcomes were all-cause mortality in the short-term, mid-term and long-term follow-up. A total of 23 studies pooling 15812 patients were included. Compared to TAVI alone, PCI-TAVI showed no significant difference in all-cause mortality at short- and mid-term (RRshort-term = 1.10 95%CI 0.88-1.38; RRmid-term = 1.12 95%CI 0.97-1.30), but an increase during long-term follow-up (RRlong-term = 1.20 95%CI 1.06-1.36). Compared with PCI-TAVI, TAVI-PCI is associated with lower rate of all-cause mortality at both short- and long-term follow-ups. PCI before or concomitant with TAVI may not offer clinical benefits and could potentially lead to worse outcomes in the long term. Conversely, PCI after TAVI is associated with improved clinical outcomes in both the short and long term.
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Wang et al. (2025) conducted a meta-analysis in Transcatheter Aortic Valve Implantation with concomitant coronary artery disease (n=15,812). Percutaneous coronary intervention (PCI) before or concomitant with TAVI vs. TAVI alone was evaluated on Long-term all-cause mortality (RR 1.20, 95% CI 1.06-1.36, p=0.005). Performing percutaneous coronary intervention before or concomitant with transcatheter aortic valve implantation increased long-term all-cause mortality (RR 1.20) compared to TAVI alone.
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