Clinical outcomes of patients undergoing percutaneous coronary intervention and transcatheter aortic valve implantation versus coronary artery bypass grafting and surgical aortic valve replacement

Abstract Background Patients with concomitant severe aortic stenosis and coronary artery disease pose a significant challenge in cardiovascular management.While traditional treatment involved surgical aortic valve replacement(SAVR) combined with coronary artery bypass grafting(CABG),transcatheter aortic valve implantation(TAVI) with percutaneous coronary intervention(PCI) has emerged as a less invasive alternative. Purpose This meta-analysis aimed to compare the short-term clinical outcomes of patients undergoing PCI-TAVI versus CABG-SAVR. Methods A systematic search of the PubMed, Cochrane, and Scopus databases was conducted to identify relevant studies that reported distinct short-term outcomes for patients undergoing PCI-TAVI versus CABG-SAVR, published up to January 15th 2025.The primary endpoint was 30-day all-cause mortality and stroke rates.Secondary endpoints included in-hospital major vascular complications,permanent pacemaker implantation(PPI) and acute kidney injury(AKI). Results A total of 136,763 patients from 7 observational and 2 randomized controlled trials(RCTs) were included, comprising 101,529 patients who underwent PCI-TAVI and 35,234 patients who received CABG-SAVR. No statistically significant difference was observed in 30-day mortality between the 2 groups(RRmortality,0.8395%CI,0.61–1.14,P=0.25),though a trend favouring PCI-TAVI was noted.Similarly,no significant difference was found in major vascular complications(RRvascular,1.7695%CI,0.51–6.09,P=0.37),although there was a trend toward a higher incidence in the PCI-TAVI group.Furthermore, PCI-TAVI was associated with significantly lower rates of 30-day stroke(RRstroke,0.8595%CI,0.73–1.00,P=0.048) and in-hospital AKI(RRAKI,0.5695%CI,0.36–0.88,P=0.01) compared to CABG-SAVR.Publication bias was not detected in funnel plot analysis,and Egger’s regression test confirmed no significant asymmetry.High heterogeneity was detected in 3/5 examined outcomes,particularly mortality.Sensitivity analysis revealed that a single study(Patlolla et al,2022) had a significant impact on the overall effect size.When this study was excluded,the adjusted analysis demonstrated a statistically significant survival advantage for PCI-TAVI,with lower 30-day mortality(RR’mortality,0.6695%CI,0.54–0.81,P0.001).The robustness and reliability of findings across different study subsets and analysis methods were confirmed through cumulative and sensitivity analyses. Conclusion This meta-analysis demonstrates that PCI-TAVI is associated with significantly lower 30-day rates of stroke and in-hospital AKI compared to CABG-SAVR, while 30-day mortality remains statistically comparable between the 2 groups.These findings highlight the evolving role of PCI-TAVI and future RCTs are necessary to validate these results.