Key result
Routine PCI before or during TAVI fails to reduce mortality and increases major bleeding.
Why the study?
Coronary artery disease commonly coexists with severe aortic stenosis in TAVI candidates, yet the optimal revascularization strategy remains debated.
Does routine percutaneous coronary intervention before or concomitant with TAVI reduce mortality and clinical events compared to conservative management in patients with severe aortic stenosis and coexisting coronary artery disease?
Meta-Analysis (n=1,156)
Randomized controlled trials included
Does routine percutaneous coronary intervention before or concomitant with TAVI reduce mortality and clinical events compared to conservative management in patients with severe aortic stenosis and coexisting coronary artery disease?
Answers are grounded in this paper and cite their sources.
Routine PCI before or concomitant with TAVI reduces subsequent revascularization without conferring survival or ischemic benefit, while significantly increasing bleeding complications, supporting an individualized, Heart Team-guided revascularization strategy.
Coronary artery disease commonly coexists with severe aortic stenosis in transcatheter aortic valve implantation (TAVI) candidates, yet optimal revascularization remains debated. We meta-analyzed randomized controlled trials comparing routine percutaneous coronary intervention (PCI) before or concomitant with TAVI versus conservative management. Major databases were searched through May 2026. Random-effects models calculated risk ratios (RRs) with 95% confidence intervals (CIs), and evidence certainty was evaluated via the Grading of Recommendations Assessment, Development and Evaluation. Three randomized controlled trials (1156 patients; PCI: n = 579, conservative: n = 577) were included. Routine PCI was not associated with significant reductions in all-cause mortality (RR, 0.90; 95% CI, 0.70–1.15; P = 0.40), cardiac death (RR, 0.74; 95% CI, 0.51–1.08; P = 0.12), myocardial infarction (RR, 0.86; 95% CI, 0.45–1.64; P = 0.64), stroke (RR, 0.70; 95% CI, 0.48–1.03; P = 0.07), or hospitalization (RR, 1.07; 95% CI, 0.87–1.32; P = 0.52). However, PCI significantly increased major bleeding (RR, 1.57; 95% CI, 1.06–2.34; P = 0.02) and any bleeding (RR, 1.77; 95% CI, 1.27–2.48; P = 0.0008), while reducing urgent and repeat revascularization. In conclusion, routine PCI before or concomitant with TAVI reduces subsequent revascularization without conferring survival or ischemic benefit, while increasing bleeding complications. Given the moderate-to-low certainty of evidence, limited cumulative sample size, and clinical heterogeneity across trials, these findings warrant cautious interpretation and favor an individualized, Heart Team-guided revascularization strategy over routine PCI.
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Mohamed et al. (2026) conducted a meta-analysis in Severe aortic stenosis and coexisting coronary artery disease undergoing transcatheter aortic valve implantation (TAVI) (n=1,156). Routine percutaneous coronary intervention (PCI) before or concomitant with TAVI vs. Conservative management was evaluated on All-cause mortality (RR 0.90, 95% CI 0.70-1.15, p=0.40). Routine PCI before or with TAVI did not reduce all-cause mortality vs conservative management (RR 0.90; 95% CI 0.70-1.15; P=0.40) and increased major bleeding (RR 1.57; P=0.02).
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