June 17, 2026Journal of the American College of Cardiology268 citations
View Full PaperSevere Aortic Stenosis and Coronary Artery Disease—Implications for Management in the Transcatheter Aortic Valve Replacement Era
Key Result
Significant coronary artery disease is present in 40% to 75% of patients undergoing TAVR, though existing data suggest not all patients require revascularization before the procedure.
Key Points
- This review aims to assess the implications of coronary artery disease on the management and outcomes of patients with severe aortic stenosis undergoing TAVR.
- Comprehensive literature review on CAD prevalence in patients referred for TAVR.
- Evaluation of management strategies for CAD in relation to TAVR outcomes.
- Analysis of ongoing studies randomizing patients to different management strategies.
- Significant CAD is present in 40% to 75% of patients undergoing TAVR.
- Not all patients require revascularization prior to TAVR, indicating a tailored approach may be necessary.
- PCI is recommended for severe stenosis in proximal coronary lesions affecting large myocardium areas.
Structured PICO
How should coronary artery disease be managed in patients with severe aortic stenosis undergoing TAVR?
P
Population
Patients with severe aortic stenosis (AS) and coronary artery disease (CAD) referred for transcatheter aortic valve replacement (TAVR)
I
Intervention
Management strategies for CAD, including percutaneous coronary intervention (PCI)
O
Outcome
Clinical impact of CAD on TAVR outcomes and management strategies
In patients undergoing TAVR, CAD is highly prevalent (40-75%), but routine revascularization is not required for all patients; PCI should be reserved for severe proximal lesions.
Limitations
- Limited and heterogeneous data on the prevalence and clinical impact of CAD on the outcomes of TAVR
Abstract
Management of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR) is posing challenges. Due to limited and heterogeneous data on the prevalence and clinical impact of CAD on the outcomes of TAVR and the management strategies for CAD in patients undergoing TAVR, we performed a comprehensive review of the literature. Significant CAD is present in 40% to 75% of patients undergoing TAVR. The impact of CAD on outcomes after TAVR remains understudied. Based on existing data, not all patients require revascularization before TAVR. Percutaneous coronary intervention (PCI) should be considered for severely stenotic lesions in proximal coronaries that subtend a large area of myocardium at risk. Ongoing studies randomizing patients to surgical or percutaneous management strategies for severe AS will help provide valuable data regarding the impact of CAD on TAVR outcomes, the role of PCI, and its timing in relation to TAVR.