Timing and Outcomes of PCI in Conjunction with TAVR with Balloon-Expandable Valves

BACKGROUND The optimal timing for percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) is debatable. OBJECTIVES The aim of this study was to compare outcomes based on the timing of PCI in stable coronary artery disease patients undergoing TAVR. METHODS Leveraging the STS/ACC TVT Registry and Medicare Linkage, we analyzed patients with stable coronary artery disease undergoing PCI and TAVR between 2015 and 2023 using the SAPIEN 3 balloon-expandable valve platform. This analysis included patients who underwent PCI within +/- 90 days of the index TAVR procedure. All-cause mortality, stroke, and a composite of mortality and stroke were analyzed up to 3 years using Medicare Linkage. RESULTS Of the 51,480 patients who underwent PCI and TAVR with SAPIEN 3 platforms during the study period, 84.7% had PCI within 90 days before TAVR, 13.9% had concomitant PCI, and 1.4% had PCI within 90 days after TAVR. In the propensity-matched analysis, patients undergoing PCI before TAVR had better outcomes in terms of all cause-mortality (38.1% vs 38.8%; P = 0.013) and a composite of mortality and stroke (42.8% vs 43.5%; P = 0.012) compared with the ones undergoing concomitant PCI at 3-year follow-up. Major vascular complications were higher in patients undergoing concomitant PCI and TAVR (2% vs 1.4%; P = 0.003) CONCLUSIONS Patients undergoing concomitant PCI and TAVR had higher major vascular complications, and slightly higher composite of all-cause mortality and stroke compared with those who underwent PCI within 90 days before the TAVR procedure. (JACC Cardiovasc Interv. 2025;18:244-254) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).