- Question
- In patients with aortic stenosis undergoing TAVI who have intermediate coronary lesions, does a physiology-guided (FFR) revascularization strategy improve clinical outcomes compared with an angiography-only approach?
- Design
- Multicentre, open-label, randomized 1:1 superiority trial with blinded adjudication of adverse events. A total of 320 patients were enrolled at 15 Italian centres, analysed by intention to treat with 12 months of follow-up.
- Population
- Patients with aortic stenosis and intermediate coronary lesions scheduled for TAVI. Median age was 86 years, median STS score 3% and median SYNTAX score 7.
- Intervention
- FFR-guided percutaneous coronary intervention (PCI): only lesions with physiologically significant values (FFR ≤0.80 per the registry) were treated, before or after TAVI.
- Control
- Angiography-guided PCI: coronary stenoses of at least 50% by visual estimation in vessels of at least 2.5 mm were treated.
- Primary outcome
- Major adverse cardiac and cerebrovascular events (MACCE) at 12 months, a composite of all-cause death, myocardial infarction, ischaemia-driven target vessel revascularization, disabling stroke or major bleeding.
- Results
- MACCE at 12 months was lower with FFR-guided than with angiography-guided PCI (8.5% vs 16.0%; HR 0.52; 95% CI 0.27-0.99; P = 0.047). The difference was mainly driven by lower all-cause mortality (HR 0.31; 95% CI 0.10-0.96).
- Conclusion
- In patients undergoing TAVI with intermediate coronary lesions, FFR-guided PCI reduced the risk of MACCE at 12 months compared with angiography-guided PCI.
- Why it matters
- It supports a physiology-based revascularization strategy in this frail, elderly population, in which the management of coronary disease alongside TAVI had been debated.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026