Meta-analysis comparing outcomes in patients undergoing transcatheter aortic valve implantation with versus without percutaneous coronary intervention.

Meta-analysis comparing outcomes in patients undergoing transcatheter aortic valve implantation with versus without percutaneous coronary intervention.

Lateef N; Khan MS; Deo VS; Yamani N; Riaz H; Virk HUH; Khan SU; Hedrick DP; Kanaan A; Reed GW; Krishnaswamy A; Puri R; Kapadia SR; Kalra A

The American journal of cardiology

2019

2019-12-01

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, I(2) = 37.5%), stroke (OR 0.7 (0.36 to 1.45), p = 0.36, I(2) = 32.8%), MI (OR 2.71 [0.55 to 12.23], p = 0.22, I(2) = 41.3%), acute kidney injury (OR 0.7 [0.46 to 1.06], p = 0.08, I(2) = 14.4%) and 1-year all-cause mortality (OR 1.19 [0.92 to 1.52], p = 0.18, I(2) = 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.

Humans; Treatment Outcome; Severity of Illness Index; Echocardiography; Coronary Angiography; Aortic Valve Stenosis/complications/diagnosis/surgery; Coronary Artery Disease/complications/diagnosis/surgery; Percutaneous Coronary Intervention/methods; Transcatheter Aortic Valve Replacement/methods

PMID: 31575422

Copyright © 2019 Elsevier Inc. All rights reserved.

journalArticle

1757-1764

11

124

1879-1913 0002-9149

NEOMED College of Medicine

Department of Internal Medicine

June2020SubmittedList

Cleveland Clinic Akron General Hospital