Transcatheter versus surgical treatment in aortic stenosis with coronary artery disease: A meta-analysis of time-to-event data on 162,305 patients

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-10-09 DOI:10.1016/j.hrtlng.2025.09.018

Ahmed Emara MD , Mohamed Emara MD , Ahmed Farid Gadelmawla MD , Mohamed R. Murad MD , Heba Aboeldahab PharmD , Mohamed S. Elgendy MBBCh , Mohamed Sabri Hassanin MD , Mohamed A. Aldemerdash MD , Ali M. Othman MD , Mohamed Khaled MBBCh , Abdalhakim Shubietah MD , Abdalrahman Assaassa MD , Vinayak N. Bapat MDMS

{"title":"Transcatheter versus surgical treatment in aortic stenosis with coronary artery disease: A meta-analysis of time-to-event data on 162,305 patients","authors":"Ahmed Emara MD , Mohamed Emara MD , Ahmed Farid Gadelmawla MD , Mohamed R. Murad MD , Heba Aboeldahab PharmD , Mohamed S. Elgendy MBBCh , Mohamed Sabri Hassanin MD , Mohamed A. Aldemerdash MD , Ali M. Othman MD , Mohamed Khaled MBBCh , Abdalhakim Shubietah MD , Abdalrahman Assaassa MD , Vinayak N. Bapat MDMS","doi":"10.1016/j.hrtlng.2025.09.018","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Severe aortic stenosis (AS) often coexists with coronary artery disease (CAD), present in about 50 % of patients undergoing valve intervention. Surgical aortic valve replacement (SAVR) with coronary artery bypass graft (CABG) has been the traditional standard, providing revascularization and durability, whereas transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) offers a less invasive option. PCI + TAVR may lower perioperative risk, but SAVR + CABG may confer superior survival, with conflicting evidence.</div></div><div><h3>Objectives</h3><div>This meta-analysis of time-to-event data aimed to compare PCI + TAVR with CABG + SAVR in patients with concomitant AS and CAD.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Web of Science, Scopus, and Cochrane databases up to March 2025. Individual patient data (IPD) were reconstructed from published Kaplan–Meier curves to estimate hazard ratios (HRs) for all-cause mortality. Dichotomous outcomes were analyzed using risk ratios (RR) with 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Fifteen studies including 162,305 patients were analyzed. PCI + TAVR was associated with higher all-cause mortality at 48 months (HR 1.29, 95 % CI 1.23–1.35, <em>p</em> < 0.001), but lower in-hospital acute kidney injury (RR 0.37, 95 % CI 0.21–0.66, <em>p</em> = 0.0007), short-term (≤30 days) major adverse cardiovascular events (RR 0.67, 95 % CI 0.50–0.91, <em>p</em> = 0.0093), and new-onset atrial fibrillation (RR 0.23, 95 % CI 0.17–0.32, <em>p</em> < 0.0001). Conversely, long-term (>30 days) myocardial infarction risk was higher (RR 1.61, 95 % CI 1.08–2.39, <em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>PCI+TAVR was associated with higher mortality or adverse event rates compared to CABG+SAVR, but lower perioperative complications. High-quality randomized trials are warranted to confirm these findings.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"75 ","pages":"Pages 184-197"},"PeriodicalIF":2.6000,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart & Lung","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0147956325002080","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Severe aortic stenosis (AS) often coexists with coronary artery disease (CAD), present in about 50 % of patients undergoing valve intervention. Surgical aortic valve replacement (SAVR) with coronary artery bypass graft (CABG) has been the traditional standard, providing revascularization and durability, whereas transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) offers a less invasive option. PCI + TAVR may lower perioperative risk, but SAVR + CABG may confer superior survival, with conflicting evidence.

Objectives

This meta-analysis of time-to-event data aimed to compare PCI + TAVR with CABG + SAVR in patients with concomitant AS and CAD.

Methods

We systematically searched PubMed, Web of Science, Scopus, and Cochrane databases up to March 2025. Individual patient data (IPD) were reconstructed from published Kaplan–Meier curves to estimate hazard ratios (HRs) for all-cause mortality. Dichotomous outcomes were analyzed using risk ratios (RR) with 95 % confidence intervals (CI).

Results

Fifteen studies including 162,305 patients were analyzed. PCI + TAVR was associated with higher all-cause mortality at 48 months (HR 1.29, 95 % CI 1.23–1.35, p < 0.001), but lower in-hospital acute kidney injury (RR 0.37, 95 % CI 0.21–0.66, p = 0.0007), short-term (≤30 days) major adverse cardiovascular events (RR 0.67, 95 % CI 0.50–0.91, p = 0.0093), and new-onset atrial fibrillation (RR 0.23, 95 % CI 0.17–0.32, p < 0.0001). Conversely, long-term (>30 days) myocardial infarction risk was higher (RR 1.61, 95 % CI 1.08–2.39, p = 0.01).

Conclusions

PCI+TAVR was associated with higher mortality or adverse event rates compared to CABG+SAVR, but lower perioperative complications. High-quality randomized trials are warranted to confirm these findings.

查看原文本刊更多论文

经导管与手术治疗合并冠状动脉疾病的主动脉狭窄：162305例患者事件发生时间数据的荟萃分析

背景：严重主动脉瓣狭窄（AS）常与冠状动脉疾病（CAD）共存，约50%的患者接受瓣膜介入治疗。外科主动脉瓣置换术（SAVR）与冠状动脉旁路移植术（CABG）一直是传统的标准，提供血运重建和持久性，而经导管主动脉瓣置换术（TAVR）与经皮冠状动脉介入治疗（PCI）提供了一种侵入性较小的选择。PCI + TAVR可能降低围手术期风险，但SAVR + CABG可能具有更高的生存率，但证据相互矛盾。目的：本荟萃分析旨在比较合并AS和CAD患者PCI + TAVR与CABG + SAVR。方法：系统检索PubMed、Web of Science、Scopus和Cochrane数据库，检索时间截止到2025年3月。根据已发表的Kaplan-Meier曲线重建个体患者数据（IPD），以估计全因死亡率的风险比（hr）。采用95%置信区间（CI）的风险比（RR）分析二分类结果。结果：15项研究共纳入162305例患者。PCI + TAVR与48个月时较高的全因死亡率（HR 1.29, 95% CI 1.23-1.35, p < 0.001）相关，但与院内急性肾损伤（RR 0.37, 95% CI 0.21-0.66, p = 0.0007）、短期（≤30天）主要不良心血管事件（RR 0.67, 95% CI 0.50-0.91, p = 0.0093）和新发房颤（RR 0.23, 95% CI 0.17-0.32, p < 0.0001）相关。相反，长期（bbb30天）心肌梗死风险较高（RR 1.61, 95% CI 1.08-2.39, p = 0.01）。结论：与CABG+SAVR相比，PCI+TAVR的死亡率或不良事件发生率更高，但围手术期并发症更低。有必要进行高质量的随机试验来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.