Should We Perform Up-Front PCI in Patients with Significant Coronary Disease Undergoing TAVR?

New randomized trial findings suggest limiting this strategy to patients with the most severe disease.

Up to 50% of patients referred for treatment of severe aortic stenosis (AS) have significant coronary artery disease (CAD). While guidelines generally recommend that these patients undergo concurrent coronary bypass grafting at the time of surgical aortic valve replacement, the optimal management for patients undergoing transcatheter aortic valve replacement (TAVR) is uncertain.

To address this gap in knowledge, researchers conducted the partially industry-funded NOTION-3 trial (NCT03058627), randomizing 455 patients with at least one significant coronary lesion (defined as an angiographic stenosis ≥90% by visual estimate or a fractional flow reserve [FFR] ≤0.8) to receive up-front percutaneous coronary intervention (PCI) or conservative tre…

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)