Related Experiment Video
Updated: Jul 3, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Percutaneous Coronary Intervention Prior to Transcatheter Aortic Valve Implantation: A Bayesian Meta-analysis of
Pedro Gomes Batista1, Railla Raquel Albino Dos Santos Silva2, Mushrin Malik3
1Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
Insights
Routine pre-transcatheter aortic valve implantation (TAVI) percutaneous coronary intervention (PCI) for coronary artery disease (CAD) offers no hard clinical benefits and may increase bleeding risk. A selective, lesion-guided approach is recommended over routine intervention for TAVI patients with CAD.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Management of coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is debated.
- Conflicting data from randomized controlled trials (RCTs) exist regarding the optimal strategy.
Purpose of the Study:
- To systematically review and meta-analyze RCTs comparing pre-TAVI percutaneous coronary intervention (PCI) versus conservative management in TAVI patients with CAD.
- To determine the clinical effectiveness and safety of pre-TAVI PCI.
Main Methods:
- Systematic review and Bayesian meta-analysis of RCTs.
- Included studies compared pre-TAVI PCI versus conservative management.
- Effect measures included risk ratios (RRs) with 95% credible intervals (CrIs) using a Bayesian random-effects model.
Main Results:
- Three RCTs with 1,156 patients were analyzed.
- Pre-TAVI PCI showed no significant benefit for myocardial infarction, all-cause mortality, acute kidney injury, rehospitalization, cardiovascular death, or stroke.
- Pre-TAVI PCI was associated with fewer subsequent revascularizations but increased the risk of major bleeding.
Conclusions:
- Pre-TAVI PCI does not provide significant clinical benefits in TAVI patients with CAD.
- Routine pre-TAVI PCI likely increases major bleeding risk without improving hard clinical outcomes.
- A selective, lesion-guided approach to managing CAD in TAVI patients is supported over routine intervention.
Background:
The optimal management of concomitant coronary artery disease (CAD) during transcatheter aortic valve implantation (TAVI) remains controversial because of conflicting data from randomized controlled trials (RCTs).
Methods:
A systematic review and Bayesian meta-analysis of RCTs (through April 2026) compared pre-TAVI percutaneous coronary intervention (PCI) vs conservative management in TAVI patients with CAD. Effect measures were risk ratios (RRs) with 95% credible intervals (CrIs) using a Bayesian random effects model.
Results:
Three RCTs involving 1156 patients were included, with 579 (50%) randomized to pre-TAVI PCI. No evidence of benefit was observed for myocardial infarction (RR, 0.83; 95% CrI, 0.44-1.60), all-cause mortality (RR, 0.92; 95% CrI, 0.62-1.35), acute kidney injury (RR, 1.01; 95% CrI, 0.41-2.73), rehospitalization (RR, 1.08; 95% CrI, 0.67-1.75), cardiovascular death (RR, 0.74; 95% CrI, 0.44-1.24), or stroke (RR, 0.71; 95% CrI, 0.42-1.20). Although pre-TAVI PCI was associated with fewer subsequent revascularizations (RR, 0.27; 95% CrI, 0.11-0.66), this outcome is vulnerable to ascertainment and treatment bias. Conversely, point estimates favored conservative management for major bleeding (RR, 1.57; 95% CrI, 0.96-2.57).
Conclusions:
Pre-TAVI PCI yielded no hard clinical benefits and likely increased major bleeding risk. Although it reduced subsequent revascularizations, a soft, clinician-driven endpoint, this did not improve hospital-free survival. These findings strongly support a selective, lesion-guided approach over routine intervention.
Registration:
PROSPERO CRD420261364736.
