How to address the coronaries in TAVI candidates: can the need for revascularization be safely determined by CT...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Imaging

Background:

• Coronary artery disease (CAD) is a common comorbidity in patients undergoing transcatheter aortic valve implantation (TAVI).
• The necessity and benefit of routine invasive coronary angiography (CA) and percutaneous coronary intervention (PCI) in TAVI candidates are under scrutiny.
• CA poses risks including kidney injury and bleeding, and may be unnecessary if computed tomography angiography (CTA) excludes significant proximal coronary stenoses.

Purpose of the Study:

• To evaluate the current practice and evolving evidence regarding routine CAD assessment and revascularization in TAVI patients.
• To discuss the potential for a more streamlined, individualized, and resource-sparing approach to TAVI treatment.

Main Methods:

• Review of current clinical practice and guideline recommendations for CAD assessment in TAVI candidates.
• Analysis of risks associated with invasive coronary angiography (CA) and percutaneous coronary intervention (PCI).
• Consideration of evidence from ongoing randomized trials challenging existing strategies.

Main Results:

• Despite risks and unclear benefits, CA and PCI for stable coronary lesions are common in TAVI patients.
• Computed tomography angiography (CTA) may obviate the need for CA in many cases.
• Ongoing trials are investigating the efficacy of current strategies, suggesting potential changes in practice.

Conclusions:

• The routine use of invasive coronary angiography (CA) and percutaneous coronary intervention (PCI) in transcatheter aortic valve implantation (TAVI) patients warrants re-evaluation.
• Future TAVI management may shift towards more individualized, risk-stratified, and resource-efficient strategies.
• Evidence from ongoing trials is expected to refine recommendations for CAD assessment and treatment in TAVI candidates.