The Canadian journal of cardiology · 2026
Percutaneous Coronary Intervention Prior to Transcatheter Aortic Valve Implantation: A Bayesian Meta-analysis of Randomized Controlled Trials.
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Batista Pedro Gomes, Albino Dos Santos Silva Railla Raquel, Malik Mushrin, Gaelzer Giulia Caldeira, Montenegro Marcela Vasconcelos, Fischer Bacca Caroline O, Giorgi Juliana
Аннотация
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.
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.