Coronary artery disease · 2026
Prior percutaneous coronary intervention versus deferral in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis of randomized controlled trials.
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Mata Emídio, Barbosa Carla, Morais Inês, Ribeiro Sílvia, Alberto Rodrigues José, Lourenço António, Fontes-Carvalho Ricardo
Аннотация
BACKGROUND: Coronary artery disease (CAD) is highly prevalent among patients undergoing transcatheter aortic valve implantation (TAVI), yet the optimal management of concomitant coronary lesions remains uncertain. While routine percutaneous coronary intervention (PCI) prior to TAVI may reduce ischemic complications, it may also increase bleeding risk and procedural burden.
METHODS: We systematically searched Cochrane Central Register of Controlled Trials, Scopus, and PubMed for randomized controlled trials (RCTs) comparing routine PCI versus PCI deferral in patients undergoing TAVI with CAD. Primary outcomes were all-cause mortality and myocardial infarction. Secondary outcomes included major bleeding, any bleeding, stroke, hospitalizations, and cardiovascular mortality. Random-effects meta-analysis was performed using hazard ratios with 95% confidence intervals (CIs).
RESULTS: Three multicenter RCTs (2021-2026), including 1132 patients (563 PCI deferral, 569 routine PCI), were analyzed. Routine PCI was not associated with differences in all-cause mortality (hazard ratio = 0.88; 95% CI = 0.67-1.17) or myocardial infarction (hazard ratio = 0.84; 95% CI = 0.44-1.58). Similarly, no significant differences were observed in stroke, hospitalizations, or cardiovascular mortality. However, routine PCI was associated with a higher risk of major bleeding (hazard ratio = 1.61; 95% CI = 1.05-2.49) and any bleeding (hazard ratio = 1.96; 95% CI = 1.28-3.00).
CONCLUSION: In patients undergoing TAVI with concomitant CAD, PCI deferral appears safe and is associated with a significantly lower bleeding risk, without increasing ischemic events. These findings support a deferral approach to coronary revascularization rather than routine PCI prior to TAVI. However, longer-term follow-up is warranted to better define the impact of this strategy on late ischemic outcomes, particularly as TAVI is increasingly performed in younger patients with longer life expectancy.
METHODS: We systematically searched Cochrane Central Register of Controlled Trials, Scopus, and PubMed for randomized controlled trials (RCTs) comparing routine PCI versus PCI deferral in patients undergoing TAVI with CAD. Primary outcomes were all-cause mortality and myocardial infarction. Secondary outcomes included major bleeding, any bleeding, stroke, hospitalizations, and cardiovascular mortality. Random-effects meta-analysis was performed using hazard ratios with 95% confidence intervals (CIs).
RESULTS: Three multicenter RCTs (2021-2026), including 1132 patients (563 PCI deferral, 569 routine PCI), were analyzed. Routine PCI was not associated with differences in all-cause mortality (hazard ratio = 0.88; 95% CI = 0.67-1.17) or myocardial infarction (hazard ratio = 0.84; 95% CI = 0.44-1.58). Similarly, no significant differences were observed in stroke, hospitalizations, or cardiovascular mortality. However, routine PCI was associated with a higher risk of major bleeding (hazard ratio = 1.61; 95% CI = 1.05-2.49) and any bleeding (hazard ratio = 1.96; 95% CI = 1.28-3.00).
CONCLUSION: In patients undergoing TAVI with concomitant CAD, PCI deferral appears safe and is associated with a significantly lower bleeding risk, without increasing ischemic events. These findings support a deferral approach to coronary revascularization rather than routine PCI prior to TAVI. However, longer-term follow-up is warranted to better define the impact of this strategy on late ischemic outcomes, particularly as TAVI is increasingly performed in younger patients with longer life expectancy.