Key result
Performing PCI within 90 days before TAVR was associated with a lower 3-year composite of mortality and stroke compared with concomitant PCI (42.8% vs 43.5%; P=0.012).
Why the study?
The optimal timing for PCI in patients undergoing TAVR is debatable.
Does performing PCI before TAVR improve clinical outcomes compared to concomitant PCI in patients with stable coronary artery disease undergoing TAVR?
Cohort (n=51,480)
Yes
Does performing PCI before TAVR improve clinical outcomes compared to concomitant PCI in patients with stable coronary artery disease undergoing TAVR?
Absolute Event Rate: 42.8% vs 43.5%
p-value: p=0.012
In patients with stable coronary artery disease undergoing TAVR, performing PCI within 90 days prior to TAVR is associated with slightly lower mortality and fewer major vascular complications compared to concomitant PCI.
Pre-TAVR PCI was associated with modestly lower mortality; leaves open optimal timing pending randomized trials.
BACKGROUND: The optimal timing for percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) is debatable. OBJECTIVES: The aim of this study was to compare outcomes based on the timing of PCI in stable coronary artery disease patients undergoing TAVR. METHODS: Leveraging the STS/ACC TVT Registry and Medicare Linkage, we analyzed patients with stable coronary artery disease undergoing PCI and TAVR between 2015 and 2023 using the SAPIEN 3 balloon-expandable valve platform. This analysis included patients who underwent PCI within ±90 days of the index TAVR procedure. All-cause mortality, stroke, and a composite of mortality and stroke were analyzed up to 3 years using Medicare Linkage. RESULTS: Of the 51,480 patients who underwent PCI and TAVR with SAPIEN 3 platforms during the study period, 84.7% had PCI within 90 days before TAVR, 13.9% had concomitant PCI, and 1.4% had PCI within 90 days after TAVR. In the propensity-matched analysis, patients undergoing PCI before TAVR had better outcomes in terms of all cause-mortality (38.1% vs 38.8%; P = 0.013) and a composite of mortality and stroke (42.8% vs 43.5%; P = 0.012) compared with the ones undergoing concomitant PCI at 3-year follow-up. Major vascular complications were higher in patients undergoing concomitant PCI and TAVR (2% vs 1.4%; P = 0.003) CONCLUSIONS: Patients undergoing concomitant PCI and TAVR had higher major vascular complications, and slightly higher composite of all-cause mortality and stroke compared with those who underwent PCI within 90 days before the TAVR procedure.
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Dhoble et al. (2025) conducted a cohort in Stable coronary artery disease undergoing TAVR (n=51,480). PCI within 90 days before TAVR vs. Concomitant PCI and TAVR was evaluated on Composite of all-cause mortality and stroke (p=0.012). Performing PCI within 90 days before TAVR was associated with a lower 3-year composite of mortality and stroke compared with concomitant PCI (42.8% vs 43.5%; P=0.012).
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