Transcatheter versus surgical treatment in aortic stenosis with coronary artery disease: A meta-analysis of time-to-event data on 162,305 patients.

BACKGROUND

Severe aortic stenosis (AS) often coexists with coronary artery disease (CAD), present in about 50 % of patients undergoing valve intervention. Surgical aortic valve replacement (SAVR) with coronary artery bypass graft (CABG) has been the traditional standard, providing revascularization and durability, whereas transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) offers a less invasive option. PCI + TAVR may lower perioperative risk, but SAVR + CABG may confer superior survival, with conflicting evidence.

OBJECTIVES

This meta-analysis of time-to-event data aimed to compare PCI + TAVR with CABG + SAVR in patients with concomitant AS and CAD.

METHODS

We systematically searched PubMed, Web of Science, Scopus, and Cochrane databases up to March 2025. Individual patient data (IPD) were reconstructed from published Kaplan-Meier curves to estimate hazard ratios (HRs) for all-cause mortality. Dichotomous outcomes were analyzed using risk ratios (RR) with 95 % confidence intervals (CI).

RESULTS

Fifteen studies including 162,305 patients were analyzed. PCI + TAVR was associated with higher all-cause mortality at 48 months (HR 1.29, 95 % CI 1.23-1.35, p < 0.001), but lower in-hospital acute kidney injury (RR 0.37, 95 % CI 0.21-0.66, p = 0.0007), short-term (≤30 days) major adverse cardiovascular events (RR 0.67, 95 % CI 0.50-0.91, p = 0.0093), and new-onset atrial fibrillation (RR 0.23, 95 % CI 0.17-0.32, p < 0.0001). Conversely, long-term (>30 days) myocardial infarction risk was higher (RR 1.61, 95 % CI 1.08-2.39, p = 0.01).

CONCLUSIONS

PCI+TAVR was associated with higher mortality or adverse event rates compared to CABG+SAVR, but lower perioperative complications. High-quality randomized trials are warranted to confirm these findings.