Overview of outcomes.

The aim of this study is to compare the clinical benefits associated with different percutaneous coronary intervention (PCI) timing strategies in patients undergoing transcatheter aortic valve implantation (TAVI) who have coexisting coronary artery disease (CAD). A systematic review and meta-analysis were conducted. PubMed, EMBASE, Cochrane Library and Web of Science databases were searched for relevant articles up to April 10th, 2024. Studies that reported comparisons of clinical outcomes between PCI before/concomitant with TAVI (PCI-TAVI) vs. TAVI alone, or comparisons between PCI before/concomitant with TAVI vs. PCI after TAVI (TAVI-PCI) were selected. Primary outcomes were all-cause mortality in the short-term, mid-term and long-term follow-up. A total of 23 studies pooling 15812 patients were included. Compared to TAVI alone, PCI-TAVI showed no significant difference in all-cause mortality at short- and mid-term (RRshort-term = 1.10 95%CI 0.88-1.38; RRmid-term = 1.12 95%CI 0.97-1.30), but an increase during long-term follow-up (RRlong-term = 1.20 95%CI 1.06-1.36). Compared with PCI-TAVI, TAVI-PCI is associated with lower rate of all-cause mortality at both short- and long-term follow-ups. PCI before or concomitant with TAVI may not offer clinical benefits and could potentially lead to worse outcomes in the long term. Conversely, PCI after TAVI is associated with improved clinical outcomes in both the short and long term.

本研究旨在探讨合并冠状动脉粥样硬化性心脏病(coronary artery disease, CAD)的经导管主动脉瓣置换术(transcatheter aortic valve implantation, TAVI)患者中，不同经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)时机策略的临床获益。本研究采用系统评价与荟萃分析方法，检索了截至2024年4月10日的PubMed、EMBASE、考科蓝图书馆(Cochrane Library)及Web of Science数据库中的相关文献。纳入对比术前/同期经皮冠状动脉介入治疗联合经导管主动脉瓣置换术（PCI-TAVI）与单纯经导管主动脉瓣置换术（TAVI alone），或术前/同期PCI-TAVI与术后经皮冠状动脉介入治疗（TAVI-PCI）临床结局的研究。主要结局指标为短期、中期及长期随访的全因死亡率。最终共纳入23项研究，合计15812例患者。与单纯TAVI相比，PCI-TAVI在短期和中期随访的全因死亡率无显著差异（短期RR=1.10，95%CI 0.88~1.38；中期RR=1.12，95%CI 0.97~1.30），但在长期随访中全因死亡率升高（RR=1.20，95%CI 1.06~1.36）。与PCI-TAVI相比，TAVI-PCI在短期及长期随访中均与更低的全因死亡率相关。术前或同期PCI联合TAVI或未带来明确临床获益，甚至可能在长期随访中导致更差的结局；反之，TAVI术后行PCI则与短期及长期临床结局改善相关。