Routine Versus Deferred Percutaneous Coronary Intervention in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-analysis With Reconstructed Individual Patient Data
6 affiliations
- 1Department of Cardiology, University Hospital of Rostock, Rostock, Germany
- 2Faculty of Medicine, Ain Shams University, Cairo, Egypt
- 3Department of Cardiology, Ahmed Maher Teaching Hospital, Cairo, Egypt
- 4Theodor Bilharz Research Institute, Giza, Egypt
- 5Department of Cardiology, National Institute of Diabetes and Endocrinology, Cairo, Egypt
- 6Emergency Department, King's College Hospital, London, United Kingdom
Abstract
Background: The optimal management of concomitant coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) remains controversial. Whether routine percutaneous coronary intervention (PCI) before TAVR provides clinical benefit compared to a strategy of deferral is unclear.
Methods: We performed a meta-analysis of randomized controlled trials (RCT) comparing routine PCI before TAVR with a strategy of PCI deferral. The primary end points were a composite of major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality. Secondary end points included myocardial infarction, stroke, revascularization, and major bleeding. We applied a random-effects model to calculate hazard ratios (HR) and 95% CI. We also performed a pooled time-to-event analysis using reconstructed individual patient data.
Results: We included 3 RCT (ACTIVATION, NOTION-3, and PRO-TAVI) comprising a total of 1156 patients. The pooled cohort had a median age exceeding 81 years and exhibited low anatomic coronary complexity (median SYNTAX score ≤10). Routine PCI did not significantly reduce the risk of MACCE (HR, 0.84; 95% CI, 0.62-1.13; P = .25) or all-cause mortality (HR, 0.88; 95% CI, 0.67-1.17; P = .38). Pooled Kaplan-Meier analysis confirmed no difference in all-cause mortality over 48 months (HR, 0.89; 95% CI, 0.68-1.17; P = .41). Although routine PCI was associated with a significant reduction in any revascularization (HR, 0.24; 95% CI, 0.06-0.89; P = .03) and urgent revascularization (HR, 0.33; 95% CI, 0.12-0.87; P = .02), it was associated with increased bleeding events (HR, 1.96; 95% CI, 1.28-3.00; P < .01). No significant differences were observed regarding myocardial infarction or stroke.
Conclusions: Routine PCI before TAVR did not reduce mortality or MACCE compared to a deferral strategy. Although routine PCI lowered the risk of subsequent urgent revascularization, it significantly increased the risk of major bleeding.
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BibTeX
@article{balata2026routine,
title = {{Routine Versus Deferred Percutaneous Coronary Intervention in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-analysis With Reconstructed Individual Patient Data}},
author = {Mahmoud Balata and Ahmed Samy Badran and Mohamed Ibrahim Gbreel and Marwa Hassan and Islam Ebeid and Abdelhakim A. Abdelrahman and Daniel Robinson and Jonas Bodanowitz and Stephan Valenta and Christin Valenta and Plamen Kochev and Hüseyin Ince and Jasmin Ortak},
journal = {Journal of the Society for Cardiovascular Angiography \& Interventions},
year = {2026},
month = aug,
doi = {10.1016/j.jscai.2026.105566},
url = {https://doi.org/10.1016/j.jscai.2026.105566},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Routine Versus Deferred Percutaneous Coronary Intervention in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-analysis With Reconstructed Individual Patient Data
AU - Mahmoud Balata
AU - Ahmed Samy Badran
AU - Mohamed Ibrahim Gbreel
AU - Marwa Hassan
AU - Islam Ebeid
AU - Abdelhakim A. Abdelrahman
AU - Daniel Robinson
AU - Jonas Bodanowitz
AU - Stephan Valenta
AU - Christin Valenta
AU - Plamen Kochev
AU - Hüseyin Ince
AU - Jasmin Ortak
PY - 2026
DA - 2026/08/04
JO - Journal of the Society for Cardiovascular Angiography & Interventions
DO - 10.1016/j.jscai.2026.105566
UR - https://doi.org/10.1016/j.jscai.2026.105566
AB - Background: The optimal management of concomitant coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) remains controversial. Whether routine percutaneous coronary intervention (PCI) before TAVR provides clinical benefit compared to a strategy of deferral is unclear. Methods: We performed a meta-analysis of randomized controlled trials (RCT) comparing routine PCI before TAVR with a strategy of PCI deferral. The primary end points were a composite of major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality. Secondary end points included myocardial infarction, stroke, revascularization, and major bleeding. We applied a random-effects model to calculate hazard ratios (HR) and 95% CI. We also performed a pooled time-to-event analysis using reconstructed individual patient data. Results: We included 3 RCT (ACTIVATION, NOTION-3, and PRO-TAVI) comprising a total of 1156 patients. The pooled cohort had a median age exceeding 81 years and exhibited low anatomic coronary complexity (median SYNTAX score ≤10). Routine PCI did not significantly reduce the risk of MACCE (HR, 0.84; 95% CI, 0.62-1.13; P = .25) or all-cause mortality (HR, 0.88; 95% CI, 0.67-1.17; P = .38). Pooled Kaplan-Meier analysis confirmed no difference in all-cause mortality over 48 months (HR, 0.89; 95% CI, 0.68-1.17; P = .41). Although routine PCI was associated with a significant reduction in any revascularization (HR, 0.24; 95% CI, 0.06-0.89; P = .03) and urgent revascularization (HR, 0.33; 95% CI, 0.12-0.87; P = .02), it was associated with increased bleeding events (HR, 1.96; 95% CI, 1.28-3.00; P < .01). No significant differences were observed regarding myocardial infarction or stroke. Conclusions: Routine PCI before TAVR did not reduce mortality or MACCE compared to a deferral strategy. Although routine PCI lowered the risk of subsequent urgent revascularization, it significantly increased the risk of major bleeding.
SN - 2772-9303
ER -