September 22, 2026Coronary Artery Disease
Prior percutaneous coronary intervention versus deferral in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis of randomized controlled trials
Key result
Routine PCI prior to TAVI did not significantly reduce all-cause mortality (HR 0.88; 95% CI 0.67-1.17) or myocardial infarction compared to PCI deferral, but increased the risk of major bleeding.
Why the study?
Does routine PCI prior to TAVI reduce all-cause mortality and myocardial infarction compared to PCI deferral in patients undergoing TAVI with CAD?
Key Points
- To evaluate whether routine percutaneous coronary intervention improves clinical outcomes compared with deferral in patients with coronary artery disease undergoing transcatheter aortic valve implantation.
- Systematic search of Cochrane Central Register of Controlled Trials, Scopus, and PubMed for randomized controlled trials comparing routine PCI with PCI deferral prior to TAVI.
- Conducted random-effects meta-analyses across 3 multicenter randomized controlled trials (2021–2026) comprising 1,132 patients (569 routine PCI, 563 PCI deferral).
Study Design
Type
Meta-Analysis (n=1,132)
Multicenter
Yes
Structured PICO
Does routine PCI prior to TAVI reduce all-cause mortality and myocardial infarction compared to PCI deferral in patients undergoing TAVI with CAD?
P
Population
1,132 patients undergoing TAVI with concomitant CAD from 3 multicenter RCTs.
I
Intervention
Routine percutaneous coronary intervention (PCI) prior to TAVI
C
Comparator
PCI deferral
O
Outcome
All-cause mortality and myocardial infarctionhard clinical
Main Result
Hazard Ratio: 0.88 (95% CI 0.67–1.17)
Limitations
- Longer-term follow-up is warranted to better define the impact on late ischemic outcomes, particularly as TAVI is increasingly performed in younger patients.
- Longer-term follow-up is warranted to better define the impact on late ischemic outcomes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“For elderly TAVR patients with concomitant coronary artery disease, I think it's safe to first do TAVR and see if patients will still have complaints about chest pain or tightness. We can wait and, if they still have complaints afterward, only then do PCI.”
PGPhilippe GarotInterventional cardiologist, Institut Cardiovasculaire Paris Sud
“In a population with a mean age above 80 years, this reduction in hemorrhagic events is clinically meaningful. Nevertheless, PRO-TAVI should not be interpreted as evidence that PCI is unnecessary in all patients undergoing TAVI.”
“We believe this data will instill confidence and provide supporting evidence for many physicians and heart teams to make decisions regarding the timing of PCI in patients undergoing TAVR.”
Implication
In patients undergoing TAVI with concomitant CAD, deferring PCI is safe and significantly lowers bleeding risk without increasing ischemic events compared to routine PCI.
Abstract
BACKGROUND: Coronary artery disease (CAD) is highly prevalent among patients undergoing transcatheter aortic valve implantation (TAVI), yet the optimal management of concomitant coronary lesions remains uncertain. While routine percutaneous coronary intervention (PCI) prior to TAVI may reduce ischemic complications, it may also increase bleeding risk and procedural burden. METHODS: We systematically searched Cochrane Central Register of Controlled Trials, Scopus, and PubMed for randomized controlled trials (RCTs) comparing routine PCI versus PCI deferral in patients undergoing TAVI with CAD. Primary outcomes were all-cause mortality and myocardial infarction. Secondary outcomes included major bleeding, any bleeding, stroke, hospitalizations, and cardiovascular mortality. Random-effects meta-analysis was performed using hazard ratios with 95% confidence intervals (CIs). RESULTS: Three multicenter RCTs (2021-2026), including 1132 patients (563 PCI deferral, 569 routine PCI), were analyzed. Routine PCI was not associated with differences in all-cause mortality (hazard ratio = 0.88; 95% CI = 0.67-1.17) or myocardial infarction (hazard ratio = 0.84; 95% CI = 0.44-1.58). Similarly, no significant differences were observed in stroke, hospitalizations, or cardiovascular mortality. However, routine PCI was associated with a higher risk of major bleeding (hazard ratio = 1.61; 95% CI = 1.05-2.49) and any bleeding (hazard ratio = 1.96; 95% CI = 1.28-3.00). CONCLUSION: In patients undergoing TAVI with concomitant CAD, PCI deferral appears safe and is associated with a significantly lower bleeding risk, without increasing ischemic events. These findings support a deferral approach to coronary revascularization rather than routine PCI prior to TAVI. However, longer-term follow-up is warranted to better define the impact of this strategy on late ischemic outcomes, particularly as TAVI is increasingly performed in younger patients with longer life expectancy.
Discussion
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Cite This Study
Mata et al. (2026) conducted a meta-analysis in Transcatheter aortic valve implantation (TAVI) with concomitant coronary artery disease (CAD) (n=1,132). Routine percutaneous coronary intervention (PCI) vs. PCI deferral was evaluated on All-cause mortality (HR 0.88, 95% CI 0.67-1.17). Routine PCI prior to TAVI did not significantly reduce all-cause mortality (HR 0.88; 95% CI 0.67-1.17) or myocardial infarction compared to PCI deferral, but increased the risk of major bleeding.