Key result
Routine PCI did not reduce spontaneous myocardial infarction or all-cause mortality compared to deferred PCI in patients undergoing TAVI, but increased bleeding complications.
Why the study?
The optimal management of concomitant coronary artery disease in patients undergoing transcatheter aortic valve implantation remains debated.
Does routine percutaneous coronary intervention reduce spontaneous myocardial infarction in patients with severe aortic stenosis and concomitant coronary artery disease undergoing TAVI?
Meta-Analysis (n=1,156)
Yes
Does routine percutaneous coronary intervention reduce spontaneous myocardial infarction in patients with severe aortic stenosis and concomitant coronary artery disease undergoing TAVI?
Routine PCI in TAVI candidates with concomitant CAD does not improve hard ischemic outcomes or mortality but significantly increases the risk of bleeding, supporting a selective revascularization approach.
Answers are grounded in this paper and cite their sources.
Routine PCI should be avoided in TAVI patients with CAD; challenges routine revascularization and supports selective deferred strategies in guidelines and trials.
Background: The optimal management of concomitant coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) remains debated. Therefore, we performed this meta-analysis of randomized controlled trials (RCTs) to compare routine percutaneous coronary intervention (PCI) versus deferred PCI in patients with severe aortic stenosis and significant coronary artery disease undergoing TAVI. Methods: We systematically searched major electronic databases for eligible RCTs. The primary efficacy outcome was spontaneous myocardial infarction (MI); the primary safety outcome was major bleeding. Bayesian random-effects meta-analysis models were fitted using weakly informative prior distributions. Effect estimates are reported as posterior median risk ratios (RR) with 95% credible intervals (CrI). The posterior probability of benefit (PPB) for efficacy outcomes or harm (PPH) for safety outcomes was calculated (RR < 1 or RR > 1, respectively). Results: Three RCTs comprising 1156 patients were included. Routine PCI did not demonstrate a convincing posterior probability of benefit for spontaneous MI (posterior median RR 0.84, 95% CrI 0.43-1.73; PPB: 70.2%) or all-cause mortality (posterior median RR 0.91, 95% CrI 0.60-1.43; PPB: 69.6%). However, routine PCI was associated with a reduced risk of urgent revascularization (posterior median RR 0.37, 95% CrI 0.15-0.91; PPB: 98.1%). For safety outcomes, routine PCI was associated with an increased posterior probability of harm for major bleeding (posterior median RR 1.56, 95% CrI 0.91-2.71; PPH: 95.6%) and life-threatening or disabling bleeding (posterior median RR 1.74, 95% CrI 1.00-3.07; PPH: 97.4%). Conclusions: Among patients undergoing TAVI with concomitant CAD, routine PCI did not reduce ischemic events or mortality but increased bleeding complications. These findings suggest that a selective revascularization strategy, rather than a routine one, may be preferable. PROSPERO registration: CRD420261386909.
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Ibrahim et al. (2026) conducted a meta-analysis in Severe aortic stenosis and concomitant significant coronary artery disease undergoing TAVI (n=1,156). Routine percutaneous coronary intervention (PCI) vs. Deferred PCI (conservative management or deferral until clinically indicated) was evaluated on Spontaneous myocardial infarction (RR 0.84, 95% CI 0.43-1.73). Routine PCI did not reduce spontaneous myocardial infarction or all-cause mortality compared to deferred PCI in patients undergoing TAVI, but increased bleeding complications.
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