Feasibility and safety of combined percutaneous coronary intervention among high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. (2nd July 2018)

• Record Type: Journal Article
• Authors: Bao, Liming; Gao, Qing; Chen, Shenglong; Chen, Yu; Elhmidi, Yacine; Shehada, Sharaf-Eldin; Wang, Sheng; Ma, Chenming
• Is Part Of: European journal of cardio-thoracic surgery. Volume 54:Number 6(2018)
• Page Start: 1052
• Page End: 1059
• Publication Date: 2018-07-02
• Subjects: Percutaneous coronary intervention -- Aortic valve stenosis -- Transcatheter aortic valve implantation -- Coronary artery disease -- Meta-analysis; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezy240
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: Recent reports indicated that percutaneous coronary intervention (PCI) may be correlated with increased mortality in patients undergoing transcatheter aortic valve implantation (TAVI). Therefore, we performed a meta-analysis to determine the feasibility and safety of combined PCI in high-risk patients with severe aortic stenosis undergoing TAVI. METHODS: A comprehensive literature search was performed using PubMed, Embase and the Cochrane Central Register of Controlled trials through June 2016. RESULTS: Five clinical trials including 1634 patients were identified. The pooled analysis revealed no significant differences in 30-day all-cause mortality [odds ratio (OR) 1.25, 95% confidence interval (CI) 0.52–3.05; P = 0.62], 30-day cardiovascular mortality rate (OR 1.59, 95% CI 0.52–4.88; P = 0.41) and 1-year mortality rate (OR 1.16, 95% CI 0.85–1.59; P = 0.34) among the patients assigned to TAVI and those undergoing TAVI+PCI. The incidence of myocardial infarction (OR 2.96, 95% CI 1.03–8.45; P = 0.04) was slightly higher in the TAVI+PCI group. Other complications, such as stroke, kidney injury, bleeding and vascular complications, were not significantly increased in the TAVI+PCI group. Patients treated with a staged procedure of TAVI and PCI but not simultaneous TAVI+PCI showed higher 30-day all-cause mortality as compared to those undergoing isolated TAVI. CONCLUSIONS: Combined TAVI+PCI showed similar rates of death from any cause at 30 days and 1 year as compared to isolated TAVI. Except for myocardial infarction, the rate of operative complications in the TAVI+PCI group was not detrimental as compared to the isolated TAVI group. The simultaneous treatment of significant coronary artery lesions may be preferred in selected patients undergoing TAVI.