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Percutaneous Coronary Intervention before or after Transcatheter Aortic Valve Replacement: A Systematic Review and

Rodolfo Caminiti1,2, Alfonso Ielasi1, Giampaolo Vetta3

  • 1U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, 20157 Milan, Italy.

Journal of Clinical Medicine
|June 27, 2024
PubMed

Insights

For patients with stable coronary artery disease undergoing transcatheter aortic valve replacement (TAVR), performing percutaneous coronary intervention (PCI) after TAVR is linked to reduced mortality compared to performing PCI before TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Optimal timing for percutaneous coronary interventions (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear.
  • This study addresses the clinical question of whether PCI should precede or follow TAVR.

Purpose of the Study:

  • To compare clinical outcomes between patients who underwent PCI before TAVR versus after TAVR.
  • To evaluate the impact of PCI timing on mortality, stroke, and myocardial infarction (MI).

Main Methods:

  • A meta-analysis was conducted using data from Medline, Embase, and Cochrane databases up to April 5, 2024.
  • Included studies compared PCI timing relative to TAVR, reporting on mortality, stroke, and MI.
  • PROSPERO registration: CRD42023470417.

Main Results:

  • Three studies with 1531 patients (1240 pre-TAVR PCI, 291 post-TAVR PCI) were analyzed.
  • Mortality was significantly higher in the pre-TAVR PCI group (OR: 2.48; 95% CI: 1.19-5.20; p=0.02).
  • No significant differences were observed for stroke (OR: 3.58; 95% CI: 0.70-18.15; p=0.12) or MI (OR: 0.66; 95% CI: 0.30-1.42; p=0.29) between the groups.

Conclusions:

  • For patients with stable coronary artery disease undergoing TAVR, PCI performed after TAVR is associated with lower mortality.
  • The findings suggest a potential benefit in deferring PCI until after TAVR in select patient populations.

Keywords:
PCIaortic stenosiscoronary artery diseasetranscatheter aortic valve implantation

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