AI Article Synopsis
- - Prior studies on the effectiveness of revascularization before transcatheter aortic valve replacement (TAVR) have shown mixed results in patients with significant coronary artery disease (CAD), leading to this meta-analysis to evaluate outcomes more comprehensively.
- - The analysis included 24 studies with over 12,000 TAVR patients, revealing no significant difference in 30-day or 1-year mortality rates between those who underwent pre-TAVR PCI and those who did not, along with minimal differences in other major complications.
- - The study concluded that routine pre-TAVR revascularization does not improve survival rates, but it does increase the risk of life-threatening bleeding, suggesting that future research should focus on identifying patients who might
Article Abstract
Background: Prior studies on revascularization prior to transcatheter aortic valve replacement (TAVR), in patients with significant coronary artery disease (CAD), have reported mixed results.
Aim: We sought to perform a meta-analysis combining current evidence by investigating outcomes of revascularization in patients who undergo TAVR with coexisting CAD.
Methods: We searched literature for studies reporting on outcomes following TAVR performed with versus without pre-TAVR PCI, for coexisting CAD. Random-effect model was used to pool estimates of odds ratios (ORs).
Results: Twenty-four reports with 12,182 TAVR patients were included: 22 observational and 2 clinical trials. 4,110 (33.7%) were in the pre-TAVR PCI group, 51.4% were females, and mean age was 81.9 years. The 30-day mortality was 5.2% versus 5.0% in patients with versus without pre-TAVR PCI, respectively [OR= 1.19 (95% CI: 0.91-1.55, P= 0.20)]. Pooled 1-year mortality was 18.1% versus 19.1% in patients with versus without pre-TAVR PCI (OR= 1.12, 95% CI: 0.95-1.31, P= 0.61). There was no significant difference between the groups for myocardial infarction, stroke, acute kidney injury, pacemaker implantation, or re-hospitalization. Pre-TAVR PCI was associated with an increased risk of life-threatening bleeding at 30 days.
Conclusion: Pre-TAVR revascularization with PCI was not associated with improved 30-day or 1-year mortality; however, it was associated with an increased risk of life-threatening bleeding at 30-day post-TAVR. Our results do not support routine revascularization with PCI prior to TAVR with coexisting CAD. Future trials addressing anatomical complexity and symptom burden may help better risk stratify patients who may benefit from pre-TAVR revascularization.
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| http://dx.doi.org/10.1016/j.cpcardiol.2022.101339 | DOI Listing |
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