TAVR and PCI: When heart patients need both, does the order matter?
When patients present with severe aortic stenosis and coronary artery disease (CAD), performing transcatheter aortic valve replacement (TAVR) first is noninferior to performing percutaneous coronary intervention (PCI) first, according to new one-year data presented at ESC Congress 2026 in Munich, Germany. The findings were simultaneously published in The New England Journal of Medicine.[1]
The TAVI-PCI trial included nearly 1,000 patients with both severe aortic stenosis and CAD. Patients were treated at one of 48 different facilities throughout Europe. Patients were randomized to either undergo TAVR first or PCI first. The trial’s primary endpoint—a composite of all-cause mortality, nonfatal myocardial infarction, ischemia-driven revascularization, major bleeding events, treatment-related rehospitalization and heart failure-related hospitalization—occurred in 22.2% of patients treated with TAVR first and 24.2% of patients treated with PCI first. Reviewing these data, the authors determined that a TAVR-first strategy is noninferior to a PCI-first strategy.
One takeaway that stood out to the study’s authors was the number of TAVR-first patients who ultimately did not end up undergoing PCI.
“Importantly, this was not because coronary access was impaired after TAVR,” first author Barbara Elisabeth Stähli, MD, MPH, a researcher from the University Hospital Zurich in Switzerland, said in a statement. “Rather, once the valve had been treated, the clinical decision about whether PCI was still necessary sometimes changed.”
Stähli emphasized that these data suggest multidisciplinary heart teams can now confidently choose either approach to managing patients with both severe aortic stenosis and CAD.
“The results of the TAVI PCI trial demonstrate that we as clinicians now have a choice,” she said. “The trial provides randomized evidence to individualize the treatment strategy according to what is best for each patient. In patients for whom both TAVI and PCI were planned, a TAVI-first strategy was noninferior to a PCI-first strategy at one year. PCI therefore does not necessarily have to come first. For some patients, there may be good reasons to treat the coronary arteries first. For others, treating the valve first may make more sense.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.