Percutaneous Coronary Intervention Before Transcatheter Aortic Valve Implantation in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis
Zaryab Bacha, Hunain Shahbaz, Ashbala Yasir, Haya Afridi, Areefa Rashad, Hooria Muneer, Faryal Gohar, Maria Khan, Muhammad Ayyan Chaudhary, Aysha Rehman, Muntaha Abid, Muhammad Shayan Afridi, Masooma Naqvi, Farishta Mahboob Khan, Shaza Rahat, Faraz Rafi, Ali Fatehi HassanabadConcomitant coronary artery disease affects 40–75% of patients undergoing transcatheter aortic valve implantation (TAVI). Three recent randomized trials yielded conflicting findings: NOTION-3 demonstrated reduced composite events with pre-TAVI percutaneous coronary intervention (PCI), whereas PRO-TAVI showed non-inferiority of PCI deferral with less bleeding; neither demonstrated mortality benefit. No previous meta-analysis combined all 3 trials with observational evidence, applied design-stratified GRADE certainty, or explored cardiovascular mortality heterogeneity. We performed a systematic review and meta-analysis of 16 studies (3 randomized trials, 13 observational cohorts; 8,207 patients). Ten prespecified outcomes were pooled using Mantel–Haenszel random-effects risk ratios (RRs) with 95% confidence intervals (CIs); 30-day all-cause mortality was primary. GRADE certainty was assessed separately for randomized and observational evidence. Prespecified design-based subgroup and leave-one-out sensitivity analyses were performed.
Pre-TAVI PCI was not associated with significant differences in 30-day all-cause mortality (RR 1.26, 95% CI 0.90–1.77;