Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta-Analysis

Rafail A. Kotronias, Chun Shing Kwok, Sudhakar George, Davide Capodanno, Peter F. Ludman, Jonathan N. Townend, Sagar N. Doshi, Saib S. Khogali, Philippe Généreux, Howard C. Herrmann, Mamas A. Mamas, Rodrigo Bagur

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

METHODS AND RESULTS: We conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random-effects meta-analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta-analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95% confidence interval [CI], 1.33-2.60; P=0.0003) and higher 30-day mortality (OR: 1.42; 95% CI, 1.08-1.87; P=0.01). There were no differences in effect estimates for 30-day cardiovascular mortality (OR: 1.03; 95% CI, 0.35-2.99), myocardial infarction (OR: 0.86; 95% CI, 0.14-5.28), acute kidney injury (OR: 0.89; 95% CI, 0.42-1.88), stroke (OR: 1.07; 95% CI, 0.38-2.97), or 1-year mortality (OR: 1.05; 95% CI, 0.71-1.56). The timing of percutaneous coronary intervention (same setting versus a priori) did not negatively influence outcomes.

CONCLUSIONS: Our analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient-important clinical outcomes and may be associated with an increased risk of major vascular complications and 30-day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.

BACKGROUND: Recent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta-analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume6
Issue number6
DOIs
StatePublished - Jun 27 2017

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Percutaneous Coronary Intervention
Meta-Analysis
Coronary Vessels
Odds Ratio
Confidence Intervals
Mortality
Blood Vessels
Coronary Artery Disease
Aortic Valve Stenosis
Transcatheter Aortic Valve Replacement
Acute Kidney Injury
Stroke
Myocardial Infarction
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kotronias, Rafail A. ; Kwok, Chun Shing ; George, Sudhakar ; Capodanno, Davide ; Ludman, Peter F. ; Townend, Jonathan N. ; Doshi, Sagar N. ; Khogali, Saib S. ; Généreux, Philippe ; Herrmann, Howard C. ; Mamas, Mamas A. ; Bagur, Rodrigo. / Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy : A Systematic Review and Meta-Analysis. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 6.
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title = "Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta-Analysis",
abstract = "METHODS AND RESULTS: We conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random-effects meta-analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta-analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95{\%} confidence interval [CI], 1.33-2.60; P=0.0003) and higher 30-day mortality (OR: 1.42; 95{\%} CI, 1.08-1.87; P=0.01). There were no differences in effect estimates for 30-day cardiovascular mortality (OR: 1.03; 95{\%} CI, 0.35-2.99), myocardial infarction (OR: 0.86; 95{\%} CI, 0.14-5.28), acute kidney injury (OR: 0.89; 95{\%} CI, 0.42-1.88), stroke (OR: 1.07; 95{\%} CI, 0.38-2.97), or 1-year mortality (OR: 1.05; 95{\%} CI, 0.71-1.56). The timing of percutaneous coronary intervention (same setting versus a priori) did not negatively influence outcomes.CONCLUSIONS: Our analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient-important clinical outcomes and may be associated with an increased risk of major vascular complications and 30-day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.BACKGROUND: Recent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta-analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation.",
author = "Kotronias, {Rafail A.} and Kwok, {Chun Shing} and Sudhakar George and Davide Capodanno and Ludman, {Peter F.} and Townend, {Jonathan N.} and Doshi, {Sagar N.} and Khogali, {Saib S.} and Philippe G{\'e}n{\'e}reux and Herrmann, {Howard C.} and Mamas, {Mamas A.} and Rodrigo Bagur",
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Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy : A Systematic Review and Meta-Analysis. / Kotronias, Rafail A.; Kwok, Chun Shing; George, Sudhakar; Capodanno, Davide; Ludman, Peter F.; Townend, Jonathan N.; Doshi, Sagar N.; Khogali, Saib S.; Généreux, Philippe; Herrmann, Howard C.; Mamas, Mamas A.; Bagur, Rodrigo.

In: Journal of the American Heart Association, Vol. 6, No. 6, 27.06.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy

T2 - A Systematic Review and Meta-Analysis

AU - Kotronias, Rafail A.

AU - Kwok, Chun Shing

AU - George, Sudhakar

AU - Capodanno, Davide

AU - Ludman, Peter F.

AU - Townend, Jonathan N.

AU - Doshi, Sagar N.

AU - Khogali, Saib S.

AU - Généreux, Philippe

AU - Herrmann, Howard C.

AU - Mamas, Mamas A.

AU - Bagur, Rodrigo

PY - 2017/6/27

Y1 - 2017/6/27

N2 - METHODS AND RESULTS: We conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random-effects meta-analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta-analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95% confidence interval [CI], 1.33-2.60; P=0.0003) and higher 30-day mortality (OR: 1.42; 95% CI, 1.08-1.87; P=0.01). There were no differences in effect estimates for 30-day cardiovascular mortality (OR: 1.03; 95% CI, 0.35-2.99), myocardial infarction (OR: 0.86; 95% CI, 0.14-5.28), acute kidney injury (OR: 0.89; 95% CI, 0.42-1.88), stroke (OR: 1.07; 95% CI, 0.38-2.97), or 1-year mortality (OR: 1.05; 95% CI, 0.71-1.56). The timing of percutaneous coronary intervention (same setting versus a priori) did not negatively influence outcomes.CONCLUSIONS: Our analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient-important clinical outcomes and may be associated with an increased risk of major vascular complications and 30-day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.BACKGROUND: Recent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta-analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation.

AB - METHODS AND RESULTS: We conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random-effects meta-analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta-analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95% confidence interval [CI], 1.33-2.60; P=0.0003) and higher 30-day mortality (OR: 1.42; 95% CI, 1.08-1.87; P=0.01). There were no differences in effect estimates for 30-day cardiovascular mortality (OR: 1.03; 95% CI, 0.35-2.99), myocardial infarction (OR: 0.86; 95% CI, 0.14-5.28), acute kidney injury (OR: 0.89; 95% CI, 0.42-1.88), stroke (OR: 1.07; 95% CI, 0.38-2.97), or 1-year mortality (OR: 1.05; 95% CI, 0.71-1.56). The timing of percutaneous coronary intervention (same setting versus a priori) did not negatively influence outcomes.CONCLUSIONS: Our analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient-important clinical outcomes and may be associated with an increased risk of major vascular complications and 30-day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.BACKGROUND: Recent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta-analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation.

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