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Clinical Outcomes of Transcatheter Aortic Valve Replacement With and Without Percutaneous Coronary Intervention-An

Mohammad Yassen1, Abdelmoniem Moustafa2, Barat Venkataramany3

  • 1Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States.

Current Problems in Cardiology
|July 20, 2023
PubMed

Insights

Adding percutaneous coronary intervention (PCI) to transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) with coronary artery disease (CAD) does not improve survival. This combined approach did not reduce mortality but increased heart attack risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe aortic stenosis (AS) and obstructive coronary artery disease (CAD) often coexist in high-risk patients.
  • Transcatheter aortic valve replacement (TAVR) is a standard treatment for severe AS.
  • The survival benefit of combining TAVR with percutaneous coronary intervention (PCI) remains unclear.

Approach:

  • A systematic literature review and meta-analysis was conducted.
  • PubMed, Embase, and Cochrane Library databases were searched from inception to June 2023.
  • Eleven studies with 2804 patients were analyzed to compare outcomes of TAVR alone versus TAVR+PCI.

Key Points:

  • Concomitant PCI with TAVR showed no significant difference in 30-day or 6-month to 1-year all-cause mortality.
  • 30-day cardiovascular mortality was not significantly reduced by the addition of PCI.
  • Rates of myocardial infarction were significantly higher in the TAVR+PCI group.

Conclusions:

  • Percutaneous coronary intervention (PCI) does not provide a mortality benefit when performed concurrently with transcatheter aortic valve replacement (TAVR) in patients with obstructive coronary artery disease (CAD).
  • The combined TAVR and PCI strategy did not improve survival outcomes but was associated with an increased risk of myocardial infarction.
  • Further research is warranted to definitively establish the role of concomitant PCI in this patient population.

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