Comparing Complete Revascularization Using PCI Versus Medical Management in Patients With Symptomatic Aortic Stenosis Undergoing Elective Transfemoral Transcatheter Aortic Valve Replacement

What this Trial Is About

This research aims to evaluate the best way to manage coronary artery disease CAD in patients undergoing transcatheter aortic valve replacement TAVR for severe aortic stenosis. Since many patients have both conditions, the study compares whether performing staged complete revascularization using percutaneous coronary intervention PCI with drug-eluting stents is better than medical therapy alone. The goal is to understand which approach improves outcomes such as cardiovascular death, heart attacks, and hospitalizations. Patients will be randomly assigned to one of two groups. One group receives staged PCI to treat all suitable coronary artery lesions with at least 70% narrowing in vessels 2.5 mm or larger, performed between 1 and 45 days after successful TAVR. The other group receives only guideline-directed medical therapy without additional revascularization. All participants receive optimal medical care for their heart conditions. Participants will be followed for a median of 3.5 years. Researchers will monitor major heart-related events including cardiovascular death, new heart attacks, ischemia-driven revascularization, and hospitalizations for unstable angina or heart failure. Assessments include echocardiographic measurements, patient-reported outcomes, and economic evaluations. Safety and long-term effects will also be observed to guide future care for patients with both severe aortic stenosis and coronary artery disease.

Staged Complete Revascularization for Coronary Artery Disease vs Medical Management Alone in Patients With AS Undergoing Transcatheter Aortic Valve Replacement