What does this research mean for the field?

Post-TAVI PCI is associated with significantly lower risk of all-cause mortality compared to pre-TAVI and concurrent PCI strategies in patients with severe aortic stenosis and coronary artery disease. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

February 8, 2026

Optimal timing of percutaneous coronary intervention in patients with severe aortic stenosis and coronary artery disease undergoing transcatheter aortic valve implantation

Key Result

Post-TAVI PCI was associated with significantly lower all-cause mortality versus pre-TAVI PCI (OR 2.11) and concurrent PCI (OR 1.50) in severe AS with CAD patients.

Key Points

This meta-analysis aims to determine the optimal timing of percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation.
Conducted a literature search across databases including Pubmed, Embase, and Web of Science.
Included studies assessing the timing of PCI relative to TAVI and its association with all-cause mortality.
Categorized patients into groups based on timing of PCI: pre-TAVI, concurrent, and post-TAVI.
Post-TAVI PCI was linked to a significantly lower risk of all-cause mortality compared to pre-TAVI and concurrent PCI.
No significant mortality difference was noted between pre-TAVI PCI and concurrent PCI.
A total of 8 studies with 8,506 patients were analyzed, showing a follow-up period of approximately 10.5 months.

Structured PICO

Does staged post-TAVI PCI reduce all-cause mortality compared to pre-TAVI or concurrent PCI in patients with severe aortic stenosis and coronary artery disease undergoing TAVI?

Population

8,506 patients from 8 studies with severe aortic stenosis and coronary artery disease undergoing TAVI, mean age 81 years, 55% men.

Intervention

Staged post-TAVI PCI

Comparator

Pre-TAVI PCI or concurrent PCI at the time of TAVI

Outcome

All-cause mortalityhard clinical

In patients with severe aortic stenosis and coronary artery disease, deferring PCI until after TAVI may be associated with a lower risk of mortality compared to pre-TAVI or concurrent PCI.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Although patients with severe aortic stenosis (AS) often also have significant concomitant coronary artery disease (CAD), the optimal timing of percutaneous coronary intervention (PCI) in relation to transcatheter aortic valve implantation (TAVI) remains uncertain. Purpose This meta-analysis evaluates the association of pre-TAVI PCI, concurrent PCI at the time of TAVI, and post-TAVI PCI on risk of all-cause mortality. Methods A literature search was conducted using the databases Pubmed, Embase, and Web of Science, looking for studies that evaluated the association of different timing of PCI with risk of the primary endpoint, all-cause mortality, in patients with CAD and severe AS undergoing TAVI. The search was not restricted by time or publication status. Results A total of 8 studies including 8,506 patients met the inclusion criteria. Patients were categorized into three groups: pre-TAVI PCI (n=2,323), concurrent PCI at TAVI (n=1,635), and staged post-TAVI PCI (n=4,548). The mean follow-up duration was 10.5 months, the mean age was 81 years, and 55% of the cohort were men. Compared to both pre-TAVI PCI and concurrent PCI strategies, post-TAVI PCI was associated with a significantly lower risk of all-cause mortality on follow-up in patients with CAD and severe AS (OR 2.11, 95% CI 1.41-3.17; p0.01; OR 1.50, 95% CI 1.0-2.23; p=0.05). There was no significant difference in risk of all-cause mortality between pre-TAVI PCI and concurrent PCI at the time of TAVI (OR 0.95, 95% CI 0.77-1.19; p=0.68). Conclusion Based on the findings from this meta-analysis, deferring PCI until after TAVI may be associated with lower risk of mortality compared to performing PCI prior to or at the time of TAVI. However, additional high quality studies are needed to further establish these findings and to optimize the revascularization strategies for this patient population.Figure 1

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