Why the study?
Coronary artery disease frequently coexists in patients undergoing TAVR, yet the efficacy and safety of routine PCI before TAVR compared with conservative or deferred revascularization remained uncertain.
Does routine percutaneous coronary intervention before transcatheter aortic valve replacement reduce major adverse cardiac events and ischemic outcomes compared with conservative or deferred revascularization in patients with concomitant coronary artery disease?
Meta-Analysis (n=1,156)
Yes
Does routine percutaneous coronary intervention before transcatheter aortic valve replacement reduce major adverse cardiac events and ischemic outcomes compared with conservative or deferred revascularization in patients with concomitant coronary artery disease?
Answers are grounded in this paper and cite their sources.
Routine PCI prior to TAVR in patients with coexisting coronary artery disease lowers the risk of urgent revascularization at the expense of increased bleeding, without demonstrating a significant reduction in major adverse cardiac events or mortality.
BACKGROUND: Coronary artery disease frequently coexists in patients undergoing transcatheter aortic valve replacement (TAVR), yet the benefit of routine percutaneous coronary intervention (PCI) before TAVR remains uncertain. OBJECTIVES: To evaluate the efficacy and safety of routine PCI before TAVR compared with conservative or deferred revascularization. METHODS: We pooled randomized clinical trials comparing PCI before TAVR versus no/deferred PCI in patients with concomitant coronary artery disease. Random-effects models estimated pooled relative risks (RRs) with 95% confidence intervals (CIs). Bayesian sensitivity analyses and trial sequential analysis were performed. RESULTS: Three trials included 1156 patients (PCI, n = 579; no/deferred PCI, n = 577). In comparator arms reporting postrandomization PCI/revascularization, 72 of 461 patients (15.6%) underwent subsequent PCI/revascularization. PCI did not significantly reduce major adverse cardiac events (RR: 0.91, 95% CI: 0.70-1.18; I2 = 36.9%), myocardial infarction (RR: 0.86, 95% CI: 0.45-1.63; I2 = 49.8%), all-cause death (RR: 0.90, 95% CI: 0.70-1.15; I2 = 0.0%), or stroke (RR: 0.70, 95% CI: 0.48-1.03; P = 0.069; I2 = 0.0%). In two trials, PCI reduced urgent revascularization (RR: 0.33, 95% CI: 0.13-0.87; I2 = 54.5%) but increased major bleeding (RR: 1.57, 95% CI: 1.07-2.32; I2 = 37.9%) and any bleeding (RR: 1.77, 95% CI: 1.27-2.47; I2 = 66.7%). Bayesian analyses were directionally concordant. Trial sequential analysis was inconclusive for all efficacy outcomes. CONCLUSION: Routine PCI before TAVR reduced urgent revascularization but increased bleeding, without significant differences in other outcomes. Current evidence remains underpowered to rule out benefit for other ischemic outcomes; larger trials are needed.
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Mohamed et al. (2026) conducted a meta-analysis in Severe aortic stenosis undergoing TAVR with concomitant coronary artery disease (n=1,156). Routine percutaneous coronary intervention (PCI) before TAVR vs. Conservative or deferred revascularization (no/deferred PCI before TAVR) was evaluated on Major adverse cardiac events (MACE) (RR 0.91, 95% CI 0.70-1.18).
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