Routine Percutaneous Coronary Intervention Versus Conservative Management in Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Authors

Ahmed Adel Mohamed, Bandar Alawlaqi, Abdullah Moemen Ahmed, Ahmed Elhadi, Ali Samir Galal, Eslam Saber Mahmoud, Ibrahim Saeed Shahda, Habiba Mostafa, Kenzy Ahmed Mohammed, Yousef Abdul-Rafea Saad, Hamzah M Alghzawi

Published in

Cardiology in review. Nov 10, 2026. Epub Nov 10, 2026.

Abstract

Coronary artery disease commonly coexists with severe aortic stenosis in transcatheter aortic valve implantation (TAVI) candidates, yet optimal revascularization remains debated. We meta-analyzed randomized controlled trials comparing routine percutaneous coronary intervention (PCI) before or concomitant with TAVI versus conservative management. Major databases were searched through May 2026. Random-effects models calculated risk ratios (RRs) with 95% confidence intervals (CIs), and evidence certainty was evaluated via the Grading of Recommendations Assessment, Development and Evaluation. Three randomized controlled trials (1156 patients; PCI: n = 579, conservative: n = 577) were included. Routine PCI was not associated with significant reductions in all-cause mortality (RR, 0.90; 95% CI, 0.70-1.15; P = 0.40), cardiac death (RR, 0.74; 95% CI, 0.51-1.08; P = 0.12), myocardial infarction (RR, 0.86; 95% CI, 0.45-1.64; P = 0.64), stroke (RR, 0.70; 95% CI, 0.48-1.03; P = 0.07), or hospitalization (RR, 1.07; 95% CI, 0.87-1.32; P = 0.52). However, PCI significantly increased major bleeding (RR, 1.57; 95% CI, 1.06-2.34; P = 0.02) and any bleeding (RR, 1.77; 95% CI, 1.27-2.48; P = 0.0008), while reducing urgent and repeat revascularization. In conclusion, routine PCI before or concomitant with TAVI reduces subsequent revascularization without conferring survival or ischemic benefit, while increasing bleeding complications. Given the moderate-to-low certainty of evidence, limited cumulative sample size, and clinical heterogeneity across trials, these findings warrant cautious interpretation and favor an individualized, Heart Team-guided revascularization strategy over routine PCI.

PMID:
43008125
Bibliographic data and abstract were imported from PubMed on 11 Nov 2026.

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