Coronary artery disease management in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis of randomised controlled trials.

What was studied

This review pooled randomized trials. The people had severe aortic stenosis and were having TAVI. TAVI is transcatheter aortic valve implantation. The review compared routine percutaneous coronary intervention, or PCI, with conservative care. It also compared types of PCI. One type was guided by angiograms. One was guided by physiology tests. The main outcome was a set of major adverse cardiovascular events, or MACE.

What they found

The review had 1,644 people. The main analysis used 1,476. Routine PCI went with a lower risk of MACE than conservative care. The risk ratio was 0.80. Unplanned revascularisation had a risk ratio of 0.30. Major bleeding risk was higher, at 1.57. Physiology-guided PCI cut MACE, stroke and unplanned revascularisation. It ranked highest for all ischaemic outcomes.

What it means for patients

The team says routine revascularisation lowers ischaemic outcomes against conservative care. This is in people referred for TAVI. They say physiology-guided PCI may have the most favourable profile.

Why it is not certain yet

The main analysis used fewer trials than the full review. Major bleeding risk was higher with PCI. The main outcome was a study-defined composite. A review can only be as good as the studies in it.

Source

Coronary artery disease management in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis of randomised controlled trials.

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