Key result
Concomitant PCI with TAVR shows no significant increase in bleeding or vascular complications vs TAVR alone.
Why the study?
The optimal management strategy for patients undergoing TAVR with concomitant coronary artery disease remains debated.
Does concomitant PCI and TAVR increase bleeding or vascular complications compared to TAVR alone in patients with severe aortic stenosis?
Case-Control (n=60)
Yes
Does concomitant PCI and TAVR increase bleeding or vascular complications compared to TAVR alone in patients with severe aortic stenosis?
Effect estimate: Risk difference 3.3 percentage points (95% CI -12.7 to 19.7)
Absolute Event Rate: 10% vs 6.7%
p-value: p=> 0.99
Concomitant PCI and TAVR appears feasible and was not associated with a significant excess of bleeding or vascular complications compared to TAVR alone, though it significantly increased fluoroscopy time and contrast volume.
No difference in bleeding or vascular complications detected; leaves open the safety of concomitant procedures pending larger studies.
BACKGROUND: Severe aortic stenosis (AS) and coronary artery disease frequently coexist, yet the optimal management strategy for patients undergoing TAVR with concomitant CAD remains debated. Our study compared safety outcomes and procedural characteristics of concomitant TAVR and PCI versus TAVR alone in a two-center Indian population with severe AS. METHODS: This retrospective, multi-center, case-control study included 30 consecutive patients undergoing planned concomitant TAVR and PCI and 30 age-, sex-, and valve-type-matched TAVR-alone controls identified from the same study period. PCI was performed for angiographically confirmed proximal coronary stenosis ≥70% or as deemed appropriate according to the study protocol. The primary outcome was VARC-3 defined any bleeding or vascular complication through hospital dischargeSecondary outcomes included in-hospital and 30-day mortality, myocardial infarction, stroke, acute kidney injury, pacemaker implantation, fluoroscopy time, and contrast volume. RESULTS: Thirty concomitant TAVR-PCI patients and 30 matched TAVR-alone controls were included. The primary outcome occurred in 3 patients (10.0%) versus 2 patients (6.7%; p > 0.99), with a risk difference of 3.3 percentage points (95% CI, -12.7 to 19.7). No major or life-threatening bleeding events occurred. Fluoroscopy time (38.6 ± 23.2 vs. 26.8 ± 10.0 min; p < 0.01) and contrast volume (166.7 ± 65.5 vs. 99.6 ± 37.7 mL; p < 0.001) were higher with concomitant PCI. No in-hospital or 30-day deaths or myocardial infarctions occurred in either group. CONCLUSION: In this small, retrospective, two-center cohort, concomitant PCI at the time of TAVR was not associated with an observed excess of bleeding or vascular complications compared with TAVR alone. These findings are hypothesis-generating and support the feasibility of a concomitant strategy in carefully selected patients at experienced, high-volume centers; they do not establish safety equivalence.
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Rao et al. (2026) conducted a case-control in Severe aortic stenosis and coronary artery disease (n=60). Concomitant TAVR and PCI vs. TAVR alone was evaluated on VARC-3 defined any bleeding or vascular complication through hospital discharge (Risk difference 3.3 percentage points, 95% CI -12.7 to 19.7, p=> 0.99). Concomitant PCI and TAVR had similar rates of bleeding or vascular complications compared with TAVR alone (10.0% vs 6.7%; risk difference 3.3; 95% CI -12.7 to 19.7; P>0.99).
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