Abstract 4368536: Transcatheter vs. Surgical Treatment in Aortic Stenosis with Coronary Artery Disease: A Meta-Analysis of Time-to-Event Data on 162,305 Patients

Background: The optimal treatment for aortic stenosis (AS) with concomitant coronary artery disease (CAD) is controversial. Our meta-analysis of reconstructed time-to-event data aimed to compare percutaneous coronary intervention (PCI) + transcatheter aortic valve implantation (TAVI) with coronary artery bypass graft (CABG) + surgical aortic valve replacement (SAVR) in AS with CAD. Methods: We systematically searched four databases (PubMed, Web of Science, Scopus, and Cochrane Library) up to March 2025. Individual patient data (IPD) reconstructed from time-to-event data were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Dichotomous data were analyzed using risk ratios (RR) and with 95% confidence intervals (CI). Results: Our study included 15 studies with a total of 162,305 patients. PCI + TAVI significantly increased all-cause mortality compared to CABG + SAVR at 48 months (HR 1.29, 95% CI 1.23–1.35, P<0.001), however, reduced the risk of in-hospital acute kidney injury (AKI) (RR 0.37, 95% CI 0.21–0.66, P=0.0007), and on short term: major adverse cardiac event (MACE) (RR 0.67, 95% CI 0.50–0.91, P=0.0093) and new-onset atrial fibrillation (AF) (RR 0.23, 95% CI 0.17–0.32, P<0.0001). Moreover, PCI + TAVI was associated with an increased risk of myocardial infarction on long-term (RR 2.05, 95% CI 1.89–2.23, P<0.0001). Conclusions: PCI + TAVI was associated with a significantly higher all-cause mortality and an increased long-term risk of MI compared to the CABG + SAVR. However, it significantly lowered the risk of in-hospital AKI, as well as the short-term incidence of new-onset AF and MACE. However, high quality prospective clinical trials are warranted to reassess current guidelines and refine treatment recommendations.