Optimal timing for percutaneous coronary intervention in patients undergoing transcatheter aortic valve replacement: A network meta-analysis

Department

Internal Medicine

Document Type

Article

Publication Title

Cardiovascular Revascularization Medicine : Including Molecular Interventions

Abstract

Background: The optimal timing for percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) is uncertain.

Objectives: To compare different PCI timings in patients with CAD undergoing TAVR.

Methods: MEDLINE, Embase, and Cochrane were systematically searched for studies comparing different timings of PCI in patients with aortic stenosis and coronary artery disease (CAD) undergoing TAVR. PCI in a staged procedure to TAVR and PCI concomitantly to TAVR were compared with TAVR alone without PCI. A frequentist random-effects network meta-analysis calculates the odds ratio (OR) with a 95 % confidence interval (CI). Treatments were ranked using P-score analysis.

Results: Two randomized controlled trials and 24 observational studies comprising 10,901 patients with aortic stenosis and CAD were included. Compared with PCI and concomitant TAVR, staged PCI was associated with lower rates of stroke (OR 0.54; 95 % CI 0.37-0.78), myocardial infarction (OR 0.54; 95 % CI 0.31-0.91), and all-cause mortality at 30 days (OR 0.62; 95 % CI 0.41-0.95). In addition, a subgroup analysis showed that staged PCI performed after TAVR is associated with the lowest rates of all-cause mortality of all strategies. In P-score analysis, staged PCI presented the highest likelihood of preventing stroke and myocardial infarction.

Conclusion: In patients with aortic stenosis and CAD undergoing TAVR, staged PCI is associated with lower rates of stroke, myocardial infarction, and short-term mortality compared with other timings.

First Page

56

Last Page

63

DOI

10.1016/j.carrev.2025.03.007

Volume

76

Publication Date

7-1-2025

Medical Subject Headings

Aged; Aged, 80 and over; Female; Humans; Male; Aortic Valve (surgery, physiopathology, diagnostic imaging); Aortic Valve Stenosis (mortality, surgery, diagnostic imaging, physiopathology, complications); Chi-Square Distribution; Coronary Artery Disease (mortality, therapy, diagnostic imaging, complications, diagnosis); Network Meta-Analysis as Topic; Odds Ratio; Percutaneous Coronary Intervention (adverse effects, mortality); Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors; Time-to-Treatment; Transcatheter Aortic Valve Replacement (mortality, adverse effects); Treatment Outcome

Comments

Original publication had Marcos Antônio Marino as being affiliated with Rochester Regional Health, when it is Lara Almeidinha who had the affiliation.

PubMed ID

40102169

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