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Getting the latest healthcare news for you
Getting the latest healthcare news for you
For patients needing both a transcatheter aortic valve implantation (TAVI) and a coronary stent procedure (PCI), doing TAVI first is just as safe as the traditional PCI-first approach, a major randomized trial finds. Patients in the TAVI-first group also ended up needing fewer PCI procedures overall — suggesting that treating the valve first may sometimes eliminate the need for coronary intervention. A supporting meta-analysis reinforces that routine PCI before TAVI offers only modest benefit.
For decades, guidelines have recommended doing PCI (coronary stenting) before TAVI (transcatheter aortic valve replacement) in patients who need both. But the first major randomized trial to directly test this sequence — the TAVI-PCI trial — found that flipping the order is just as safe. At 1 year, adverse outcomes occurred in 22.2% of the TAVI-first group vs. 24.2% of the PCI-first group, easily meeting the bar for noninferiority.
There was also an intriguing clinical signal: patients in the TAVI-first arm ended up needing fewer PCI procedures. Researchers explained that once the valve was treated, clinicians sometimes reassessed whether coronary intervention was still necessary — not because access was blocked, but because the clinical picture changed. TAVI-first also trended toward lower rates of major bleeding (6.6% vs. 9.7%) and acute kidney injury (4.7% vs. 6.4%), though experts urged caution in interpreting these differences.
A separate patient-level meta-analysis of four randomized trials, presented at EuroPCR 2026, adds further nuance: routine PCI before TAVI offers only a modest 30% relative risk reduction in MACE — driven entirely by fewer unplanned revascularizations, with no difference in mortality, MI, or stroke. FFR-guided PCI showed the strongest benefit signal.
By the Numbers:
Why it matters: These findings challenge the longstanding default of PCI-first and suggest clinicians may have more flexibility in sequencing — or even skipping — PCI in TAVI candidates, particularly frail, elderly patients at high bleeding risk. The ongoing COMPLETE-2 trial, expected to report in 2027, may further refine these recommendations.
