Murray Cian, Ryan Caoimhe, Cronin Michael, Temperley Hugo, O'Sullivan Niall, O'Connor Stephen, Maree Andrew, Hensey Mark
Cardiology Department, St James's Hospital Dublin, Ireland.
Cardiology Department, Mater Misericordiae University Hospital Dublin, Ireland.
Interv Cardiol. 2025 Jun 19;20:e21. doi: 10.15420/icr.2024.51. eCollection 2025.
Transcatheter aortic valve implantation (TAVI) is widely performed for severe aortic stenosis (AS), often accompanied by coronary artery disease (CAD). The optimal management of CAD in TAVI patients remains uncertain. This study reviews the evidence on percutaneous coronary intervention (PCI) timing in TAVI, and proposes an algorithmic approach for CAD management.
A comprehensive search of PubMed, EMBASE and Cochrane identified studies comparing PCI timing strategies in TAVI patients.
Thirteen studies with 15,412 participants were included. Mortality at 30 days (OR 5.70; 95% CI [1.34-24.36]) and 2 years (OR 4.40; 95% CI [2.60-7.44]) were significantly higher in the combined pre-TAVI and concomitant PCI group than in the post-TAVI cohort. Rates of other periprocedural complications, such as stroke and bleeding, varied across studies.
There is no clear consensus on PCI timing in TAVI due to a lack of high-quality randomised data. An individualised, algorithmic approach is proposed for managing CAD in patients undergoing TAVI.
经导管主动脉瓣植入术（TAVI）广泛应用于严重主动脉瓣狭窄（AS）患者，这些患者常伴有冠状动脉疾病（CAD）。TAVI患者中CAD的最佳管理方案仍不明确。本研究回顾了TAVI中经皮冠状动脉介入治疗（PCI）时机的相关证据，并提出了一种CAD管理的算法方法。
全面检索PubMed、EMBASE和Cochrane数据库，以确定比较TAVI患者PCI时机策略的研究。
纳入了13项研究，共15412名参与者。TAVI术前联合PCI组30天（OR 5.70；95%CI[1.34 - 24.36]）和2年（OR 4.40；95%CI[2.60 - 7.44]）的死亡率显著高于TAVI术后队列。其他围手术期并发症的发生率，如中风和出血，在不同研究中有所不同。
由于缺乏高质量的随机数据，TAVI中PCI时机尚无明确共识。建议采用个体化的算法方法来管理接受TAVI的患者的CAD。
