TAVR-First Versus PCI-First Strategies Studied in Patients with Severe AS and Concomitant CAD

September 24, 2026—A transcatheter aortic valve replacement (TAVR) first strategy was shown to be noninferior to a percutaneous coronary intervention- (PCI-) first strategy after 1-year follow-up, according to results from the TAVI PCI trial that were presented at the European Society of Cardiology’s ESC Congress 2026 and published simultaneously by Professor Barbara E. Stähli, MD, et al in The New England Journal of Medicine.

According to ESC, the open-label, randomized, noninferiority trial was conducted at 48 centers in Austria, France, Germany, Italy, the Netherlands, and Switzerland. The study population included 986 patients, with a mean age of 82 years; 34% were women.

As summarized in the ESC press release, the study was composed of patients with severe aortic stenosis and concomitant coronary artery disease deemed eligible for both TAVR and PCI by a multidisciplinary heart team. The patients were randomized (1:1) to either TAVR followed by angiography-guided PCI (TAVR-first group) or angiography-guided PCI followed by TAVR (PCI-first group). Both procedures were completed between 1 and 45 days of each other.

The primary endpoint was a composite of all-cause death; nonfatal myocardial infarction; ischemia-driven revascularization; valve-, procedure-, or heart failure-related rehospitalization; or life-threatening, disabling, or major bleeding at 1 year.

As reported by ESC, the investigators found that the TAVR-first strategy was noninferior to the PCI-first strategy at 1 year. The primary endpoint occurred in 22.2% of patients in the TAVR-first group and 24.2% in the PCI-first group (risk difference −2.0 percentage points; 95% CI, −7.4-3.4; P for noninferiority < .001). There was no evidence of treatment heterogeneity across prespecified subgroups, for example, by age, sex and complexity of PCI.

The individual components of the primary endpoint were generally similar between the two groups, noted the ESC.

Prof. Stähli, who is from the University Hospital Zurich in Zurich, Switzerland, commented on the study in the ESC press release.

“An interesting observation was that fewer patients in the TAVI-first group ultimately underwent PCI,” stated Prof. Stähli. “Importantly, this was not because coronary access was impaired after TAVI. Rather, once the valve had been treated, the clinical decision about whether PCI was still necessary sometimes changed.”

In terms of safety, ESC reported that life-threatening, disabling, or major bleeding occurred in 6.6% of patients in the TAVR-first group and 9.7% in the PCI-first group.

Prof. Stähli stated, “BARC type 3a bleeding appeared to be less frequent with the TAVI-first strategy, although this secondary finding should be interpreted cautiously. Antiplatelet therapy and the interval between the two procedures may play a role, and these questions need further study.”

Discussing the implications of these findings, Prof. Stähli continued, “The results of the TAVI PCI trial demonstrate that we as clinicians now have a choice. The trial provides randomized evidence to individualize the treatment strategy according to what is best for each patient.

“In patients for whom both TAVI and PCI were planned, a TAVI-first strategy was noninferior to a PCI-first strategy at 1 year. PCI therefore does not necessarily have to come first. For some patients, there may be good reasons to treat the coronary arteries first. For others, treating the valve first may make more sense. Symptoms, anatomy, bleeding risk, coronary disease and the overall clinical situation all matter.”