Key result
Planned PCI before TAVR did not reduce all-cause mortality (RR 0.90; 95% CI 0.70-1.15) or MACCE, though it lowered revascularization (RR 0.25) while increasing major bleeding (RR 1.57; P=0.02).
Why the study?
Severe aortic stenosis and coronary artery disease frequently coexist in patients referred for TAVR, and whether planned PCI before valve intervention improves outcomes compared with conservative or deferred management remained uncertain.
Does planned PCI before TAVR reduce mortality and ischemic events compared with conservative or deferred management in adults with severe symptomatic aortic stenosis and significant coronary disease?
Meta-Analysis (n=1,156)
Does planned PCI before TAVR reduce mortality and ischemic events compared with conservative or deferred management in adults with severe symptomatic aortic stenosis and significant coronary disease?
Answers are grounded in this paper and cite their sources.
In patients with severe aortic stenosis and concomitant coronary disease undergoing TAVR, routine planned PCI does not improve mortality or major ischemic outcomes and increases bleeding risk despite lowering subsequent revascularization, supporting a selective rather than routine pre-TAVR PCI strategy.
Background: Severe aortic stenosis and coronary artery disease frequently coexist in patients referred for transcatheter aortic valve replacement (TAVR). Whether planned percutaneous coronary intervention (PCI) before valve intervention improves outcomes compared with conservative or deferred management remains uncertain. Research Question/Hypothesis: We hypothesized that planned PCI before TAVR would reduce ischemic events and revascularization but may increase bleeding. Methods: We conducted a PRISMA-adherent systematic review and meta-analysis of randomized controlled trials comparing planned PCI before TAVR with conservative, deferred, or no-PCI strategies in adults with severe symptomatic aortic stenosis and significant coronary disease (PROSPERO: CRD420261397950). PubMed, Cochrane, Scopus, and Web of Science were searched from inception through April 2026. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. The risk of bias was assessed using the Cochrane RoB 2 tool. Results: Three randomized trials, including 1,156 patients, were included. Planned PCI before TAVR did not significantly reduce all-cause mortality (16.2% vs 18.0%; RR 0.90, 95% CI 0.70-1.15; P=0.40), major adverse cardiovascular and cerebrovascular events (24.7% vs 27.6%; RR 0.91, 95% CI 0.70-1.18; P=0.47), cardiovascular death (7.4% vs 10.1%; RR 0.74, 95% CI 0.51-1.08; P=0.12), myocardial infarction (6.4% vs 8.3%; RR 0.86, 95% CI 0.45-1.63; P=0.64), stroke (6.9% vs 9.9%; RR 0.70, 95% CI 0.48-1.03; P=0.07), rehospitalization (RR 1.07, 95% CI 0.87-1.32; P=0.52), or acute kidney injury (RR 1.22, 95% CI 0.34-4.31; P=0.76). Planned PCI reduced urgent revascularization (2.6% vs 8.2%; RR 0.33, 95% CI 0.13-0.87; P=0.03) and any revascularization (3.7% vs 15.6%; RR 0.25, 95% CI 0.07-0.87; P=0.03), but increased major bleeding (15.7% vs 9.9%; RR 1.57, 95% CI 1.07-2.32; P=0.02) and any bleeding (37.1% vs 20.5%; RR 1.77, 95% CI 1.27-2.47; P<0.01). Conclusions: In patients with severe aortic stenosis and concomitant coronary disease undergoing TAVR, planned PCI did not improve mortality or major ischemic outcomes but reduced subsequent revascularization at the cost of increased bleeding. These findings support a selective, individualized PCI strategy rather than routine pre-TAVR revascularization.
No takes yet. Share an insight, caveat, or question.
Gowaily et al. (2026) conducted a meta-analysis in Severe symptomatic aortic stenosis and significant coronary artery disease undergoing TAVR (n=1,156). Planned percutaneous coronary intervention (PCI) before TAVR vs. Conservative, deferred, or no-PCI strategies was evaluated on All-cause mortality (RR 0.90, 95% CI 0.70-1.15, p=0.40). Planned PCI before TAVR did not reduce all-cause mortality (RR 0.90; 95% CI 0.70-1.15) or MACCE, though it lowered revascularization (RR 0.25) while increasing major bleeding (RR 1.57; P=0.02).
Synapse has enriched 10 related papers. Consider them for comparative context: