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Clinical Outcomes of Revascularization with Percutaneous Coronary Intervention Prior to Transcatheter Aortic Valve

Ahmed M Altibi1, Fares Ghanem2, Faris Hammad3

  • 1Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR.

Current Problems in Cardiology
|July 31, 2022
PubMed

Insights

Revascularization before transcatheter aortic valve replacement (TAVR) for coronary artery disease (CAD) did not improve mortality but increased bleeding risk. Routine PCI before TAVR is not supported by current evidence.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • Prior studies on revascularization before transcatheter aortic valve replacement (TAVR) in patients with significant coronary artery disease (CAD) have yielded mixed results.
  • Evidence regarding the benefits and risks of percutaneous coronary intervention (PCI) before TAVR remains inconclusive.

Purpose of the Study:

  • To conduct a meta-analysis evaluating the outcomes of revascularization in patients undergoing TAVR with coexisting CAD.
  • To synthesize current evidence on the impact of pre-TAVR PCI on mortality and other adverse events.

Main Methods:

  • A literature search was performed for studies comparing outcomes of TAVR with versus without pre-TAVR PCI in patients with CAD.
  • A random-effect model was used to pool estimates of odds ratios (ORs) for various outcomes.
  • Data from 24 reports, including 12,182 TAVR patients, were analyzed.

Main Results:

  • No significant difference in 30-day mortality (5.2% vs. 5.0%) or 1-year mortality (18.1% vs. 19.1%) was observed between patients with and without pre-TAVR PCI.
  • There were no significant differences in rates of myocardial infarction, stroke, acute kidney injury, pacemaker implantation, or re-hospitalization.
  • Pre-TAVR PCI was associated with an increased risk of life-threatening bleeding at 30 days post-TAVR.

Conclusions:

  • Pre-TAVR revascularization with PCI does not improve 30-day or 1-year mortality in patients with CAD undergoing TAVR.
  • Pre-TAVR PCI increases the risk of life-threatening bleeding within 30 days post-TAVR.
  • Current evidence does not support routine revascularization with PCI prior to TAVR in patients with coexisting CAD; further trials are needed for better risk stratification.
Abstract

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