Key result
Concomitant PCI and TAVR achieves similar procedural success compared to a staged strategy.
Why the study?
The clinical outcomes comparing concomitant versus staged PCI in patients with severe aortic valve disease and significant coronary artery stenosis undergoing TAVR required evaluation.
Does concomitant percutaneous coronary intervention (PCI) improve procedural success and early clinical outcomes compared to staged PCI in patients with severe aortic valve disease and significant coronary artery stenosis undergoing transcatheter aortic valve replacement (TAVR)?
Cohort (n=180)
No
Does concomitant percutaneous coronary intervention (PCI) improve procedural success and early clinical outcomes compared to staged PCI in patients with severe aortic valve disease and significant coronary artery stenosis undergoing transcatheter aortic valve replacement (TAVR)?
Absolute Event Rate: 92.2% vs 97.4%
p-value: p=0.467
In patients undergoing TAVR with significant coronary artery disease, both concomitant and staged PCI strategies during the same hospitalization achieved high procedural success with no significant differences in early clinical outcomes.
Comparable outcomes with concomitant versus staged PCI in TAVR; leaves open optimal timing pending randomized trials.
AIM: This study aims to compare the clinical outcomes of concomitant versus staged percutaneous coronary intervention (PCI) in patients with severe aortic valve disease and significant coronary artery stenosis undergoing transcatheter aortic valve replacement (TAVR).METHODS: We retrospectively analyzed 180 patients with severe aortic valve disease and significant coronary artery stenosis who underwent TAVR with PCI during the same hospitalization. Patients were treated using either a concomitant strategy (PCI and TAVR performed on the same day) or a staged strategy (procedures performed on different days). Procedural success, valve hemodynamics, and perioperative complications were compared between strategies.RESULTS: Overall procedural success was achieved in 168 of 180 patients (93.3%), without a significant difference between the concomitant and staged groups (92.2% vs. 97.4%, p = 0.467). Transvalvular pressure gradients decreased markedly after TAVR in both groups, from 81.7 (66.3, 99.6) mmHg to 20.0 (12.7, 24.8) mmHg in the concomitant group and from 75.2 (63.2, 97.8) mmHg to 14.9 (8.4, 27.3) mmHg in the staged group (both p < 0.001). Perioperative mortality occurred in 6 (4.3%) patients in the concomitant group and in none of the staged group (p = 0.343). Rates of permanent pacemaker implantation (1.4% vs. 0%), myocardial infarction (0.7% vs. 2.6%), major bleeding (2.1% vs. 0%), stroke (5.0% vs. 0%), and acute kidney injury (13.5% vs. 12.8%) were infrequent in both groups (all p-values > 0.05).CONCLUSIONS: In this cohort, both concomitant and staged PCI strategies achieve high procedural success, and no statistically significant differences in early clinical outcomes are observed between the two strategies. Nevertheless, the definitive optimal timing of PCI remains to be elucidated by future large-scale studies with extended follow-up.
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Tan et al. (2026) conducted a cohort in Severe aortic valve disease and significant coronary artery stenosis (n=180). Concomitant PCI and TAVR vs. Staged PCI and TAVR was evaluated on Composite procedural success (technical success of both TAVR and PCI, absence of perioperative mortality, favorable hemodynamic performance at discharge, no unplanned cardiac surgical interventions) (p=0.467). Concomitant percutaneous coronary intervention and transcatheter aortic valve replacement achieved a similar procedural success rate compared to a staged strategy (92.2% vs. 97.4%, p=0.467).
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