Renal Outcomes of Staged Versus Concomitant Percutaneous Coronary Intervention and Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Background

The optimal timing of percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear, particularly regarding its impact on renal outcomes.

Methods

We conducted systematic review and meta-analysis of studies comparing staged versus concomitant PCI in patients with aortic stenosis and coronary artery disease undergoing TAVR. We searched MEDLINE, Embase, and Cochrane databases comprehensively. Using a random-effects model, we calculated odds ratios (OR) with 95% confidence intervals (CI) to assess the incidence of contrast-induced acute coronary injury (CI-AKI) across different stages.

Results

The analysis included 11 studies encompassing 7,119 patients. Overall, staged PCI did not significantly differ from concomitant PCI in reducing CI-AKI (OR 1.02; 95% CI 0.53 to 1.98; p = 0.959; Figure 1A). Subgroup analysis revealed no significant differences in stage 1 (OR 1.99; 95% CI 0.38 to 10.47; p = 0.417; Figure 1B) or stage 2 CI-AKI (OR 1.01; 95% CI 0.39 to 2.64; p = 0.978; Figure 1C). However, a statistically significant difference emerged for stage 3/4 CI-AKI, favoring the staged approach (OR 0.48; 95% CI 0.24 to 0.99; p = 0.046; Figure 1D).

Primary Endpoints for CI-AKI

Legend: Compared to concomitant procedures, PCI and TAVI in a staged approach significantly reduced the odds of stages 3 or 4 CI-AKI in patients with CAD and SAS.

Conclusion

While staged PCI does not consistently reduce CI-AKI in patients undergoing TAVR, it may offer potential benefits for more severe kidney injury (stages 3/4). Given the observed heterogeneity, large-scale randomized controlled trials are essential to establish the relationship between procedural timing and renal outcomes.