Single-session strategy for severe aortic stenosis with coronary disease: a retrospective observational study

Abstract Background/Introduction The coexistence of severe aortic stenosis and coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is a common and clinically significant scenario. However, the optimal timing of percutaneous coronary intervention (PCI) in this population remains an unresolved question. Purpose This study aimed to compare the outcomes of patients undergoing PCI either prior to or simultaneously with transfemoral TAVI. Methods This retrospective observational study included 212 consecutive high-risk patients with severe symptomatic aortic stenosis and angiographically significant CAD, treated between January 2019 and December 2024. All procedures were performed by the same heart team using self-expanding valves. Patients were stratified according to PCI timing: staged PCI performed 7–45 days before TAVI (Pre-TAVI PCI group, n=98) or PCI performed during the same procedural session as TAVI (Simultaneous PCI-TAVI group, n=114). Propensity score matching generated 50 well-balanced pairs. The primary endpoint was all-cause mortality at 3 years; secondary endpoints included major bleeding, major vascular complications, transfusion requirements, stroke, myocardial infarction, and unplanned cardiovascular rehospitalization. Results In the unmatched cohort, Simultaneous PCI-TAVI was associated with lower rates of major bleeding (4% vs. 10%, p=0.048) and transfusion of ≥2 red blood cell units (12% vs. 26%, p=0.014). These differences remained significant after matching (major bleeding: 2% vs. 10%, p=0.042; transfusion: 6% vs. 22%, p=0.021). Three-year all-cause mortality was significantly lower in the Simultaneous group in both the unmatched (23% vs. 32%, log-rank p=0.037; adjusted hazard ratio HR 1.81, 95% confidence interval CI 1.03–3.21, p=0.039) and matched cohorts (22% vs. 36%, log-rank p=0.029; adjusted HR 0.51, 95% CI 0.27–0.95, p=0.033) (Figure 1). Cardiovascular mortality was significantly reduced with the Simultaneous approach in the matched cohort (6% vs. 24%, log-rank p=0.021; adjusted HR 0.23, 95% CI 0.06–0.81, p=0.022) (Figure 2). No significant differences were observed for stroke, myocardial infarction, or acute kidney injury. Conclusion In patients with severe aortic stenosis and concomitant CAD, a Simultaneous PCI-TAVI strategy was associated with significantly lower 3-year all-cause and cardiovascular mortality, reduced major bleeding, and fewer transfusion requirements compared with a staged Pre-TAVI PCI approach. These findings support consideration of a single-session strategy in appropriately selected patients to optimize procedural safety and long-term survival.Figure 1For image description, please refer to the figure legend and surrounding text. Figure 2For image description, please refer to the figure legend and surrounding text.