Ole De Backer and Daniel Blackman discuss the management of coronary artery disease in TAVI candidates at #europcr 2026, focusing on whether PCI should be performed before valve implantation or can be safely deferred.
They review PROTAVI, which supports a more selective strategy with PCI only when clinically indicated, suggesting less bleeding without clear harm from deferral. They contrast this with NOTION-3, which suggests a potential benefit of more systematic revascularisation before TAVI, but with important differences in design and endpoint definitions, particularly the inclusion of revascularisation in the primary outcome.
Overall, the discussion highlights that there is no universal strategy and that decisions should be individualised based on coronary complexity, ischaemic risk, and bleeding risk.
They also address a key clinical question often overlooked: how to manage patients with angina symptoms and whether valve treatment should still come first, followed by reassessment of coronary disease after TAVI.
A practical discussion on a complex and evolving area of TAVI care!
