Valvular & structural heart diseaseCohort study
Percutaneous Coronary Intervention (PCI) Versus Conservative Management Before Transcatheter Aortic Valve Replacement (TAVR) in Patients With Significant Coronary Artery Disease: A Nationwide Instrumental Variable Analysis
- observational study
- instrumental variable analysis
- nationwide Swedish registry data
Authors' conclusion
In this nationwide cohort, PCI before TAVR did not improve survival or reduce urgent revascularization but did reduce nonurgent revascularization at the cost of increased bleeding. Decisions should be individualized, balancing ischemic and bleeding risks and considering anticipated coronary access after TAVR.
Study context
- Population
- Swedish patients with significant coronary artery disease (≥50% angiographic stenosis or physiologically significant lesions) who underwent TAVR between 2008 and 2023
- Participants
- 2,578 patients
- Exposure
- PCI before TAVR vs conservative management
- PCIn = 1,182
- Conservative managementn = 1,396reference
- Outcome
- Composite of:
- All-cause mortality
- Myocardial infarction
- Urgent revascularization
Main finding
As reported in the abstract
Instrumental variable-adjusted hazard ratio
0.98
95% CI 0.85–1.14
P = 0.80
PCI vs Conservative management
instrumental variable-adjusted hazard ratio 0.98 (95% CI 0.85–1.14); P = 0.80
Observational data: associations, not effects.
Secondary outcomes
| Outcome | adjusted hazard ratio (95% CI) | P value | |
|---|---|---|---|
| Any revascularization · lower risk with PCI | 0.46 (0.30–0.72) | adjusted P =0.002 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
All-cause mortality, myocardial infarction, cardiovascular death, stroke, urgent revascularization
- No significant difference
Safety
| Outcome | instrumental variable-adjusted odds ratio (95% CI) | P value | |
|---|---|---|---|
| Bleeding · higher risk with PCI | 1.59 (1.23–2.04) | adjusted P =0.002 | |
| 0.512Instrumental variable-adjusted odds ratio (log scale) |
Original publication
PCI Versus Conservative Management Before TAVR in Patients With Significant Coronary Artery Disease: A Nationwide Instrumental Variable Analysis. Circ Cardiovasc Interv. Published 20 February 2026. doi:10.1161/circinterventions.125.016337
Summarised from the published abstract; every number is checked against it