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Valvular & structural heart disease

Impact of Extent of Coronary Artery Disease in Transcatheter Aortic Valve Replacement

JACC Cardiovasc IntervPublished

  • substudy of the PRO-TAVI trial
  • post hoc
  • patients stratified by SYNTAX score (SS) quartiles
+2 more
  • post hoc
  • patients stratified by SYNTAX score (SS) quartiles
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Authors' conclusion

In patients with concomitant coronary artery disease undergoing TAVR, deferral of PCI reduced bleeding risk and appeared safe across all SS categories. Deferral of PCI in patients with more complex coronary artery disease (SS >17) was associated with higher risk for the ischemic composite outcome. These post hoc findings require confirmation in randomized trials. (Percutaneous Coronary Intervention Before Transcatheter Aortic Valve Implantation [PRO-TAVI]; NCT05078619).

Study context

Population
Patients with significant coronary artery disease undergoing transcatheter aortic valve replacement (TAVR) randomized to deferral of percutaneous coronary intervention (PCI) or PCI before TAVRpatients with significant coronary artery disease undergoing TAVR
Participants
466 patients
Comparison
Deferral of PCI vs PCI before TAVR, across SYNTAX score categories
Primary endpoint
Composite of:
  • All-cause mortality
  • Myocardial infarction
  • Stroke
  • Major bleeding
Follow-up
1 year

Primary result

As reported in the abstract

  • The primary composite outcome did not differ across SS categories between the deferral and PCI groups
  • 1-year follow-up completed by all but 1 patient

Further findings

Outcomedeferral groupPCI groupadjusted HR (95% CI)P value
Ischemic composite outcome (all-cause mortality, myocardial infarction, and stroke), patients with SS >17 · driven primarily by all-cause mortality and stroke30.9%14.8%2.43 (1.04–5.64)P = 0.04

Safety

Bleeding events

Bleeding events were less frequent in the deferral group across all SS subgroups

Original publication

Impact of Extent of Coronary Artery Disease in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. Published 12 October 2026. doi:10.1016/j.jcin.2026.07.034
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Summarised from the published abstract; every number is checked against it