TAVI PCIHot Line 7Structural Heart

TAVI PCI

Percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation

Presenting authorBarbara Elisabeth StähliInterventional / Structural Cardiology · University of Bern

Prof. Dr. med. Barbara E. Stähli is Senior Physician, Vice Director of the Department of Cardiology, and Head of the Andreas Grüntzig Cardiac Catheterization Laboratories at University Hospital Zurich. She is Assistant Professor for Coronary Heart Disease at the University of Zurich since 2021. She previously held an attending physician position in interventional cardiology at Charité Universitätsmedizin Berlin and completed an interventional cardiology fellowship at the Montreal Heart Institute.

Overview

Percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation

Key result

Percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation has pending results from a late-breaking trial at ESC Congress 2026.

Discussion

Expert reaction lands here the moment TAVI PCI reports.

Expert takes

The PRO-TAVI trial randomized 466 older patients (median age 81) with severe aortic stenosis and coronary artery disease to PCI before TAVI or deferral of PCI, finding that deferral was noninferior for the composite of death, MI, stroke, or major bleeding at 1 year (24.1% vs 25.8%; P<0.001 for noninferiority). Deferral was associated with significantly less major bleeding (6.2% vs 14.8%), and only 11% of deferred patients ultimately required PCI. Reaction has been generally supportive of the findings but with important caveats about applicability to younger, lower-risk populations and the contrast with the NOTION-3 trial which favored PCI.

Michiel Voskuil

Interventional cardiologist, University Medical Center Utrecht

“For elderly TAVR patients with concomitant coronary artery disease, I think it's safe to first do TAVR and see if patients will still have complaints about chest pain or tightness. We can wait and, if they still have complaints afterward, only then do PCI.”

University Medical Center Utrecht

Ronak Delewi

Professor, Amsterdam UMC

“By performing PCI, the blood vessel opens up again, but PCI in these patients is burdensome and not without risk. In the PRO-TAVI study, we wanted to know if it is safe to omit the standard PCI before the TAVI procedure. We now see that it is possible: it is less burdensome for the patient and reduces the risk of bleeding.”

Amsterdam UMC

Philippe Garot

Interventional cardiologist, Institut Cardiovasculaire Paris Sud

“In a population with a mean age above 80 years, this reduction in hemorrhagic events is clinically meaningful. Nevertheless, PRO-TAVI should not be interpreted as evidence that PCI is unnecessary in all patients undergoing TAVR.”

Institut Cardiovasculaire Paris Sud

Michiel Voskuil

Interventional cardiologist, University Medical Center Utrecht

“Now that we know the operation is just as safe without PCI, we can save a lot by not performing this procedure. It not only reduces healthcare costs but is also much less burdensome for the patient.”

University Medical Center Utrecht

Main Result

Absolute Event Rate: 0% vs 0%

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