Key result
Routine PCI cuts MACE ~20% compared with conservative management in patients undergoing TAVI.
Why the study?
The optimal management of coronary artery disease in patients with severe aortic stenosis undergoing TAVI and the relative effectiveness of individual revascularisation strategies remain uncertain.
Does routine coronary revascularisation with PCI reduce major adverse cardiovascular events compared with conservative management in patients with severe aortic stenosis and coronary artery disease undergoing TAVI?
Meta-Analysis (n=1,644)
Does routine coronary revascularisation with PCI reduce major adverse cardiovascular events compared with conservative management in patients with severe aortic stenosis and coronary artery disease undergoing TAVI?
In patients with severe aortic stenosis and CAD undergoing TAVI, routine PCI—particularly physiology-guided PCI—reduces MACE and unplanned revascularisation compared with conservative management, though at the cost of increased major bleeding.
BACKGROUND: The optimal management of coronary artery disease in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) remains uncertain. AIMS: We aimed to compare clinical outcomes between routine coronary revascularisation and conservative management in patients undergoing TAVI and to assess the relative effectiveness of individual revascularisation strategies by performing a meta-analysis of randomised trials. METHODS: We conducted a pairwise meta-analysis comparing percutaneous coronary intervention (PCI) with conservative treatment and a network meta-analysis comparing the relative effectiveness of individual strategies, including angiography-guided and physiology-guided PCI. The primary outcome was a study-defined composite endpoint of major adverse cardiovascular events (MACE). Secondary endpoints included the individual outcomes of all-cause death, cardiovascular death, myocardial infarction, stroke, unplanned revascularisation, and major bleeding. RESULTS: Five trials (N=1,644 patients) were included in the systematic review, and four were included in the primary quantitative synthesis (N=1,476). Compared with conservative treatment, routine PCI was associated with lower risks of MACE (risk ratio [RR] 0.80, 95% confidence interval [CI]: 0.65-0.98) and unplanned revascularisation (RR 0.30, 95% CI: 0.11-0.83) and an increased risk of major bleeding (RR 1.57, 95% CI: 1.07-2.32). In the network meta-analysis, physiology-guided PCI significantly reduced MACE, stroke, and unplanned revascularisation compared with conservative treatment and ranked highest for all ischaemic outcomes among revascularisation strategies. CONCLUSIONS: Among patients referred for TAVI, routine revascularisation reduces the risk of ischaemic outcomes compared with conservative treatment. In this setting, physiology-guided PCI may be associated with the most favourable efficacy profile across available strategies. (PROSPERO: CRD420261330194).
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Bujak et al. (2026) conducted a meta-analysis in Coronary artery disease and severe aortic stenosis (n=1,644). Routine percutaneous coronary intervention (PCI) vs. Conservative management was evaluated on Study-defined composite endpoint of major adverse cardiovascular events (MACE) (RR 0.80, 95% CI 0.65-0.98). Routine PCI reduced major adverse cardiovascular events compared with conservative management in patients undergoing TAVI (RR 0.80, 95% CI: 0.65-0.98).
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