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Complete versus incomplete coronary revascularisation in patients undergoing PCI after TAVI

Carlo Andrea Pivato1,2, Nicole Fontana3,4, Leon Gramss1,2

  • 1IRCCS Humanitas Research Hospital, Rozzano, Lombardy, Italy.

Open Heart
|August 11, 2026
PubMed

Insights

Complete revascularization (CR) after transcatheter aortic valve implantation (TAVI) is common but does not improve outcomes compared to incomplete revascularization (ICR). These findings suggest a selective approach to CR in high-risk TAVI patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Optimal revascularization strategy post-transcatheter aortic valve implantation (TAVI) for percutaneous coronary intervention (PCI) remains unclear.
  • The prognostic impact of complete revascularization (CR) versus incomplete revascularization (ICR) in TAVI patients undergoing PCI is unknown.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes comparing CR and ICR in patients who underwent PCI after TAVI.

Main Methods:

  • Analysis of 447 patients from the Revascularization After Transcatheter Aortic Valve Implantation (REVIVAL) registry (2008-2023).
  • Patients classified as CR or ICR based on residual stenosis post-PCI.
  • Primary endpoint: 4-year incidence of major adverse cardiovascular events (MACE). Weighted Cox regression used for confounder adjustment.

Main Results:

  • CR achieved in 70.5% of patients, ICR in 29.5%.
  • Crude 4-year MACE incidence: 34.7% for CR vs. 35.0% for ICR (p=0.710).
  • Adjusted analysis showed no significant difference in MACE between CR and ICR groups (34.1% vs. 32.5%; p=0.971).

Conclusions:

  • Complete revascularization (CR) after TAVI was common but not associated with improved outcomes compared to incomplete revascularization (ICR).
  • Results support a selective, rather than systematic, pursuit of CR in elderly, high-risk post-TAVI patients.
Abstract

Keywords:
Aortic Valve StenosisCORONARY ARTERY DISEASECardiac CatheterizationPercutaneous Coronary InterventionTranscatheter Aortic Valve Replacement

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