- Question
- Does percutaneous coronary intervention (PCI) benefit patients with stable coronary artery disease and severe aortic stenosis who are undergoing transcatheter aortic-valve implantation (TAVI), compared with conservative treatment?
- Design
- International, randomized 1:1, open-label (no masking) trial of 455 patients. Median follow-up was 2 years.
- Population
- Patients with severe symptomatic aortic stenosis and at least one coronary stenosis with fractional flow reserve (FFR) ≤ 0.80 or diameter stenosis ≥ 90%. Median age was 82 years and median STS risk score was 3%.
- Intervention
- PCI (FFR-guided revascularization of suitable lesions) in addition to TAVI.
- Control
- Conservative treatment, i.e., TAVI alone without PCI.
- Primary outcome
- Major adverse cardiac event, defined as a composite of death from any cause, myocardial infarction, or urgent revascularization.
- Results
- The primary end point occurred in 60 patients (26%) in the PCI group and in 81 (36%) in the conservative-treatment group (HR 0.71; 95% CI 0.51 to 0.99; P = 0.04).
- Safety
- Bleeding events occurred in 64 patients (28%) with PCI versus 45 (20%) with conservative treatment (HR 1.51; 95% CI 1.03 to 2.22). In the PCI group, 7 patients (3%) had procedure-related complications.
- Conclusion
- Among patients with coronary artery disease undergoing TAVI, PCI was associated with a lower risk of death, myocardial infarction, or urgent revascularization than conservative treatment at a median follow-up of 2 years.
- Why it matters
- It provided randomized evidence on a long-debated question: whether to revascularize stable coronary disease around TAVI, and supports considering physiology-guided PCI in these patients while weighing the higher bleeding risk.
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