Patients having transcatheter aortic valve implantation (TAVI) routinely undergo coronary
angiography before the procedure to define the coronary anatomy and to evaluate the
extend of coronary artery disease (CAD). Whether percutaneous coronary intervention
(PCI) prior/concomitant with TAVI confers any additional clinical benefit in patients
with CAD remains unclear. Literature search was performed using Medline, Embase, Google
Scholar, and Scopus from inception of these databases till April 2019. Included outcomes
were 30-day all-cause mortality, stroke, myocardial infarction (MI), acute kidney
injury, and 1-year mortality. The main summary estimate was random effects odds ratio
(OR) with 95% confidence intervals (CIs). Eleven cohort studies enrolling 5,580 patients
(mean age 82.4 years and 52.6% females) were included. Our study found no difference
in effect estimates for 30-day all-cause mortality (OR 1.30 [0.85 to 1.98], p = 0.22,
I2 = 37.5%), stroke (OR 0.7 (0.36 to 1.45), p = 0.36, I2 = 32.8%), MI (OR 2.71 [0.55 to 12.23], p = 0.22, I2 = 41.3%), acute kidney injury (OR 0.7 [0.46 to 1.06], p = 0.08, I2 = 14.4%) and 1-year all-cause mortality (OR 1.19 [0.92 to 1.52], p = 0.18, I2 = 0.0%) in patients who underwent TAVI with and without PCI. In conclusion, our analysis
indicates that PCI with TAVI in patients with severe aortic stenosis and concomitant
CAD grants no additional clinical advantage in terms of patient important clinical
outcomes. Further randomized studies are needed to better delineate the clinical practice
for myocardial revascularization in patients receiving transcatheter therapy for aortic
valve disease.
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Article info
Publication history
Published online: September 25, 2019
Received in revised form:
August 27,
2019
Received:
August 11,
2019
Footnotes
Funding: No funding sources to declare.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
