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Review
. 2019 Dec 1;124(11):1757-1764.
doi: 10.1016/j.amjcard.2019.08.024. Epub 2019 Sep 26.

Meta-Analysis Comparing Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation With Versus Without Percutaneous Coronary Intervention

Noman Lateef  1 , Muhammad Shahzeb Khan  2 , Salil V Deo  3 , Naser Yamani  2 , Haris Riaz  4 , Hafeez Ul Hassan Virk  5 , Safi U Khan  6 , David P Hedrick  7 , Anmar Kanaan  7 , Grant W Reed  4 , Amar Krishnaswamy  4 , Rishi Puri  4 , Samir R Kapadia  4 , Ankur Kalra  8
Affiliations
Review

Meta-Analysis Comparing Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation With Versus Without Percutaneous Coronary Intervention

Noman Lateef et al. Am J Cardiol. .

Abstract

Patients having transcatheter aortic valve implantation (TAVI) routinely undergo coronary angiography before the procedure to define the coronary anatomy and to evaluate the extend of coronary artery disease (CAD). Whether percutaneous coronary intervention (PCI) prior/concomitant with TAVI confers any additional clinical benefit in patients with CAD remains unclear. Literature search was performed using Medline, Embase, Google Scholar, and Scopus from inception of these databases till April 2019. Included outcomes were 30-day all-cause mortality, stroke, myocardial infarction (MI), acute kidney injury, and 1-year mortality. The main summary estimate was random effects odds ratio (OR) with 95% confidence intervals (CIs). Eleven cohort studies enrolling 5,580 patients (mean age 82.4 years and 52.6% females) were included. Our study found no difference in effect estimates for 30-day all-cause mortality (OR 1.30 [0.85 to 1.98], p = 0.22, I2 = 37.5%), stroke (OR 0.7 (0.36 to 1.45), p = 0.36, I2 = 32.8%), MI (OR 2.71 [0.55 to 12.23], p = 0.22, I2 = 41.3%), acute kidney injury (OR 0.7 [0.46 to 1.06], p = 0.08, I2 = 14.4%) and 1-year all-cause mortality (OR 1.19 [0.92 to 1.52], p = 0.18, I2 = 0.0%) in patients who underwent TAVI with and without PCI. In conclusion, our analysis indicates that PCI with TAVI in patients with severe aortic stenosis and concomitant CAD grants no additional clinical advantage in terms of patient important clinical outcomes. Further randomized studies are needed to better delineate the clinical practice for myocardial revascularization in patients receiving transcatheter therapy for aortic valve disease.

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Conflict of interest statement

Disclosures

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram illustrating study selection process.
Figure 2.
Figure 2.
Forest Plot evaluating the cumulative risk of 30-day all-cause mortality in patients with TAVI and PCI versus TAVI Alone. Other annotations as in Figure 3. Squares represent the risk ratio of the individual studies; Horizontal lines represent the 95% confidence intervals (CI) of the risk ratio. The size of the squares reflects the weight that the corresponding study contributes in the meta-analysis. The diamonds represent the pooled risk ratio or the overall effect. PCI = percutaneous coronary intervention; TAVI = transcatheter aortic valve implantation.
Figure 3.
Figure 3.
Forest Plot evaluating the cumulative risk of 1-year all-cause mortality in patients with TAVI and PCI versus TAVI Alone. Other annotations as in Figure 2.
Figure 4.
Figure 4.
Forest Plot evaluating the cumulative risk of myocardial infarction (MI) in patients with TAVI and PCI versus TAVI Alone. Other annotations as in Figure 2.
Figure 5.
Figure 5.
Forest Plot evaluating the cumulative risk of stroke in patients with TAVI and PCI versus TAVI alone.
See this image and copyright information in PMC

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