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J Am Heart Assoc. 2017 Jun 27;6(6). pii: e005960. doi: 10.1161/JAHA.117.005960.

Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta-Analysis.

Author information

1
Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
2
Oxford University Clinical Academic Graduate School, Oxford University, Oxford, United Kingdom.
3
The Heart Centre, Royal Stoke Hospital, University Hospital of North Midlands Trust, Stoke-on-Trent, United Kingdom.
4
Cardio-Thoracic-Vascular Department, Ferrarotto Hospital University of Catania, Italy.
5
Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
6
The Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom.
7
Cardiovascular Research Foundation, New York, NY.
8
Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY.
9
Morristown Medical Center, Morristown, NJ.
10
Cardiology Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
11
Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom rodrigobagur@yahoo.com.
12
Division of Cardiology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
13
Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.

Abstract

BACKGROUND:

Recent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta-analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation.

METHODS AND RESULTS:

We conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random-effects meta-analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta-analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95% confidence interval [CI], 1.33-2.60; P=0.0003) and higher 30-day mortality (OR: 1.42; 95% CI, 1.08-1.87; P=0.01). There were no differences in effect estimates for 30-day cardiovascular mortality (OR: 1.03; 95% CI, 0.35-2.99), myocardial infarction (OR: 0.86; 95% CI, 0.14-5.28), acute kidney injury (OR: 0.89; 95% CI, 0.42-1.88), stroke (OR: 1.07; 95% CI, 0.38-2.97), or 1-year mortality (OR: 1.05; 95% CI, 0.71-1.56). The timing of percutaneous coronary intervention (same setting versus a priori) did not negatively influence outcomes.

CONCLUSIONS:

Our analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient-important clinical outcomes and may be associated with an increased risk of major vascular complications and 30-day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.

KEYWORDS:

coronary artery disease; percutaneous coronary intervention; transcatheter aortic valve implantation

PMID:
28655733
PMCID:
PMC5669191
DOI:
10.1161/JAHA.117.005960
[Indexed for MEDLINE]
Free PMC Article

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