Large registry data demonstrate PCI for stable CAD can be safely performed before, during or after TAVR

New data reveal that percutaneous coronary intervention (PCI) can be safely performed before, during, or after transcatheter aortic valve replacement (TAVR) for patients with stable coronary artery disease (CAD). The results from the analysis were presented at the Society for Cardiovascular Angiography & Interventions (SCAI) 2024 Scientific Sessions.

For those with CAD, PCI and TAVR are often required to restore blood flow. Many clinicians prefer to conduct PCI before TAVR due to the potential complications that could occur during the replacement procedure. However, the optimal timing for PCI in patients undergoing TAVR is debatable.

The analysis included 49,344 patients with stable CAD who underwent PCI before (84.7%), after (1.3%), or simultaneously (14%) with TAVR using the Sapien 3 (S3) platform balloon expandable bioprosthesis. The analysis was conducted using the TVT Registry and Medicare linkage between 2015 and 2024.

In a propensity-matched analysis, the composite of all-cause mortality and stroke were similar in three groups at three years of follow-up. The authors noted that due to the small numbers of patients undergoing PCIs after the TAVR, when they compared just the two other groups (before and concomitant PCIs), PCI performed before TAVR had a slight advantage over concomitant PCI with TAVR at three years (P=0.012).

"These findings are exciting as they slightly differ from previously published registry data," said Abhijeet Dhoble, MD, MPH, FACC, FSCAI, cardiologist at University of Texas Health Science Center at Houston, and lead author of the study. "We believe this data will instill confidence and provide supporting evidence for many physicians and heart teams to make decisions regarding the timing of PCI in patients undergoing TAVR."