Clinical Context

Patients with concomitant severe aortic stenosis and coronary artery disease represent a complex clinical population. Surgical aortic valve replacement combined with coronary artery bypass grafting has traditionally been used in this setting.

Transcatheter aortic valve implantation with percutaneous coronary intervention has emerged as a less invasive alternative, and comparative short-term outcomes are important to guide treatment selection.

Study Design

This meta-analysis included 136,763 patients from 9 studies, including 7 observational studies and 2 randomized controlled trials. Of these, 101,529 patients underwent PCI-TAVI and 35,234 underwent CABG-SAVR.

The primary endpoints were 30-day all-cause mortality and stroke, while secondary endpoints included major vascular complications, permanent pacemaker implantation, and acute kidney injury.

Key Findings

No statistically significant difference was observed in 30-day mortality between PCI-TAVI and CABG-SAVR (risk ratio [RR]: 0.83; 95% confidence interval [CI]: 0.61–1.14; P = 0.25), although a trend favoring PCI-TAVI was noted.

Similarly, major vascular complications did not differ significantly between groups (RR: 1.76; 95% CI: 0.51-6.09; P = 0.37), with a numerical trend toward higher incidence in the PCI-TAVI group.
PCI-TAVI was associated with significantly lower rates of:

• 30-day stroke (RR: 0.85; 95% CI: 0.73-1.00; P = 0.048)
• In-hospital acute kidney injury (RR: 0.56; 95% CI: 0.36-0.88; P = 0.01)

No evidence of publication bias was identified on funnel plot assessment, and Egger regression analysis did not demonstrate significant asymmetry.

High heterogeneity was observed in 3 of 5 outcomes, particularly for mortality.

Sensitivity analysis identified a single study (Patlolla et al, 2022) as having a significant impact on mortality estimates. After exclusion of this study, PCI-TAVI demonstrated significantly lower 30-day mortality (RR: 0.66; 95% CI: 0.54-0.81; P < 0.001).

The consistency of findings across cumulative and sensitivity analyses supported the robustness of the results.

Study Limitations

• High heterogeneity across outcomes, particularly mortality
• Inclusion of observational studies may introduce bias
• Mortality findings are sensitive to the exclusion of a single study

Clinical Perspective

PCI-TAVI was associated with lower rates of stroke and acute kidney injury, with comparable short-term mortality relative to CABG-SAVR. Sensitivity analysis suggests a potential survival benefit, although findings should be interpreted in the context of heterogeneity and study-level influence.

These results support the evolving role of PCI-TAVI as a less invasive option in selected patients, while emphasizing the need for further randomized evidence.

Key Takeaway

PCI-TAVI demonstrated comparable 30-day mortality with lower stroke and AKI rates compared with CABG-SAVR, with sensitivity analyses suggesting a potential mortality benefit.

Author

Vivek Pathak is Founder and Editorial Lead at MedApt, a physician-focused platform covering clinical updates, congress insights, and expert perspectives.