Key result
Percutaneous coronary intervention for significant coronary lesions in patients undergoing transcatheter aortic valve implantation is safe but has not demonstrated a clear benefit on clinical outcomes.
Why the study?
The management of CAD in patients undergoing TAVI remains controversial, and robust evidence supporting routine pre-procedural PCI or physiological lesion assessment is lacking.
Does coronary revascularization improve clinical outcomes in patients with severe aortic valve stenosis and concomitant coronary artery disease undergoing valve replacement?
Does coronary revascularization improve clinical outcomes in patients with severe aortic valve stenosis and concomitant coronary artery disease undergoing valve replacement?
Routine percutaneous coronary intervention for stable coronary artery disease prior to TAVI lacks robust evidence for prognostic benefit, highlighting a need for improved physiological lesion selection.
Lacks support for routine PCI before TAVI; leaves open the need for physiology-guided trials.
Severe aortic valve stenosis is the most frequent valve pathology in the western world and approximately 50% of these patients have concomitant coronary artery disease (CAD). Revascularization of proximal obstructive CAD in patients undergoing surgical aortic valve replacement (SAVR) is common practice considered appropriate. However, the management of patients with CAD undergoing transcatheter aortic valve implantation (TAVI) is more controversial. Nevertheless, performing percutaneous coronary intervention (PCI) of significant (>70%) proximal coronary lesions is a widely adopted strategy, but robust supporting scientific evidence is missing. Some studies suggest that complex CAD with incomplete revascularization negatively impacts outcomes post-TAVI. As increasingly younger patients are undergoing TAVI, optimizing the long-term outcomes will become more important. Although PCI in TAVI patients is safe, no benefit on outcomes has been demonstrated, possibly due to an inadequate selection of prognostically important lesions for revascularization. A possible solution might be the use of coronary physiological indices, but these have their own limitations and more data is needed to support widespread adoption. In this review we provide an overview of current evidence on the outcomes after aortic valve replacement (AVR) and the evidence regarding revascularization in this population.
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Minten et al. (2023) conducted a review in Severe aortic valve stenosis with concomitant coronary artery disease. Percutaneous coronary intervention (PCI) or Coronary artery bypass grafting (CABG) vs. No revascularization or medical therapy was evaluated. Percutaneous coronary intervention for significant coronary lesions in patients undergoing transcatheter aortic valve implantation is safe but has not demonstrated a clear benefit on clinical outcomes.
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