All-cause mortality showed a time-dependent difference between percutaneous and surgical strategies in patients with severe aortic stenosis (AS) and coronary artery disease (CAD). The findings were published in The American Journal of Cardiology and were derived from a systematic review of randomized controlled and propensity score–matched studies comparing percutaneous and surgical approaches in this population.

The analysis compared transcatheter aortic valve replacement plus percutaneous coronary intervention (TAVR plus PCI) with surgical aortic valve replacement plus coronary artery bypass grafting (SAVR plus CABG). Six studies were included, comprising 1,998 patients. Of these, 1,007 patients underwent TAVR plus PCI and 990 underwent SAVR plus CABG. Kaplan-Meier-derived individual patient data were retrieved when available. The primary endpoint was all-cause mortality.

The hazard ratio for all-cause mortality varied over time between groups. TAVR plus PCI was associated with a lower incidence of all-cause mortality during the first 19 days. A reversal occurred at 73 days, favoring SAVR plus CABG.

Patients treated with TAVR plus PCI experienced lower rates of stroke-free survival (p=0.039), postoperative reintervention (p=0.020), atrial fibrillation (p<0.001), and acute kidney injury (p=0.001). Higher risks were observed for postoperative moderate or severe aortic regurgitation (p<0.001), permanent pacemaker implantation (p=0.005), and major vascular complications (p<0.001). Major bleeding did not differ between groups (p=0.358).

The percutaneous strategy showed an early survival advantage but was associated with worse survival at mid-term follow-up in patients with AS and CAD.