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Management of Coronary Artery Disease in Patients With Severe Aortic Stenosis

Ju Hyeon Kim1, Do-Yoon Kang1, Jung-Min Ahn1

  • 1Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Korean Circulation Journal
|October 4, 2025
PubMed

Insights

Managing severe aortic stenosis (AS) and coronary artery disease (CAD) together is complex, especially with transcatheter aortic valve replacement (TAVR) in younger patients. Tailored strategies are needed for diagnosis and treatment, considering patient risk and future interventions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coexisting severe aortic stenosis (AS) and coronary artery disease (CAD) pose significant diagnostic and therapeutic challenges.
  • CAD prevalence in AS patients is high and worsens prognosis, complicating treatment decisions, especially as transcatheter aortic valve replacement (TAVR) use expands to lower-risk populations.

Purpose of the Study:

  • To review the diagnostic and therapeutic complexities of managing patients with concurrent severe AS and CAD.
  • To discuss the evolving role of TAVR in this patient subset and the implications for long-term management.

Main Methods:

  • Review of current literature and guidelines regarding the diagnosis and treatment of AS and CAD.
  • Discussion of diagnostic modalities including invasive coronary angiography and non-invasive CT angiography with CT-derived fractional flow reserve (FFR).
  • Analysis of treatment strategies, including surgical aortic valve replacement (SAVR) with bypass surgery, and TAVR with percutaneous coronary intervention (PCI), considering timing and patient risk.

Main Results:

  • Diagnostic evaluation is challenging due to overlapping symptoms and altered coronary physiology in AS.
  • Coronary computed tomography angiography with CT-derived FFR is a promising non-invasive alternative, though AS-specific FFR thresholds may be necessary.
  • Treatment strategies vary based on CAD complexity and patient risk, with a trend towards TAVR-first for non-critical lesions.
  • Commissural alignment during TAVR is vital for preserving future coronary access in younger patients.

Conclusions:

  • Optimal management requires a multidisciplinary Heart Team approach and shared decision-making.
  • Lifetime management considerations, including valve durability and planning for re-interventions, are crucial as TAVR is increasingly used in younger, lower-risk patients.
  • Individualized care strategies are essential to balance the complexities of AS and CAD in the evolving landscape of cardiac interventions.

Keywords:
Aortic stenosisCoronary artery diseaseTranscatheter aortic valve replacement

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