International journal of cardiology. Heart & vasculature · 2026
Routine versus deferred percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation: a frequentist and Bayesian meta-analysis of randomized trials with trial sequential analysis.
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Ibrahim Ahmed, Shalabi Laila, Giamundo Domenico Mario, Aboueisha Hadeel, Enani Ahmed, Assi Mariam, Mojahed Ahmed, Granata Lucio Giuseppe, Meyer Dan M, Sabouret Pierre, Andò Giuseppe
Аннотация
BACKGROUND: The optimal management of concomitant coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) remains debated. Therefore, we performed this meta-analysis of randomized controlled trials (RCTs) to compare routine percutaneous coronary intervention (PCI) versus deferred PCI in patients with severe aortic stenosis and significant coronary artery disease undergoing TAVI.
METHODS: We systematically searched major electronic databases for eligible RCTs. The primary efficacy outcome was spontaneous myocardial infarction (MI); the primary safety outcome was major bleeding. Bayesian random-effects meta-analysis models were fitted using weakly informative prior distributions. Effect estimates are reported as posterior median risk ratios (RR) with 95% credible intervals (CrI). The posterior probability of benefit (PPB) for efficacy outcomes or harm (PPH) for safety outcomes was calculated (RR < 1 or RR > 1, respectively).
RESULTS: Three RCTs comprising 1156 patients were included. Routine PCI did not demonstrate a convincing posterior probability of benefit for spontaneous MI (posterior median RR 0.84, 95% CrI 0.43-1.73; PPB: 70.2%) or all-cause mortality (posterior median RR 0.91, 95% CrI 0.60-1.43; PPB: 69.6%). However, routine PCI was associated with a reduced risk of urgent revascularization (posterior median RR 0.37, 95% CrI 0.15-0.91; PPB: 98.1%). For safety outcomes, routine PCI was associated with an increased posterior probability of harm for major bleeding (posterior median RR 1.56, 95% CrI 0.91-2.71; PPH: 95.6%) and life-threatening or disabling bleeding (posterior median RR 1.74, 95% CrI 1.00-3.07; PPH: 97.4%).
CONCLUSIONS: Among patients undergoing TAVI with concomitant CAD, routine PCI did not reduce ischemic events or mortality but increased bleeding complications. These findings suggest that a selective revascularization strategy, rather than a routine one, may be preferable.
PROSPERO REGISTRATION: CRD420261386909.
METHODS: We systematically searched major electronic databases for eligible RCTs. The primary efficacy outcome was spontaneous myocardial infarction (MI); the primary safety outcome was major bleeding. Bayesian random-effects meta-analysis models were fitted using weakly informative prior distributions. Effect estimates are reported as posterior median risk ratios (RR) with 95% credible intervals (CrI). The posterior probability of benefit (PPB) for efficacy outcomes or harm (PPH) for safety outcomes was calculated (RR < 1 or RR > 1, respectively).
RESULTS: Three RCTs comprising 1156 patients were included. Routine PCI did not demonstrate a convincing posterior probability of benefit for spontaneous MI (posterior median RR 0.84, 95% CrI 0.43-1.73; PPB: 70.2%) or all-cause mortality (posterior median RR 0.91, 95% CrI 0.60-1.43; PPB: 69.6%). However, routine PCI was associated with a reduced risk of urgent revascularization (posterior median RR 0.37, 95% CrI 0.15-0.91; PPB: 98.1%). For safety outcomes, routine PCI was associated with an increased posterior probability of harm for major bleeding (posterior median RR 1.56, 95% CrI 0.91-2.71; PPH: 95.6%) and life-threatening or disabling bleeding (posterior median RR 1.74, 95% CrI 1.00-3.07; PPH: 97.4%).
CONCLUSIONS: Among patients undergoing TAVI with concomitant CAD, routine PCI did not reduce ischemic events or mortality but increased bleeding complications. These findings suggest that a selective revascularization strategy, rather than a routine one, may be preferable.
PROSPERO REGISTRATION: CRD420261386909.