Optimal Timing of Transcatheter Aortic Valve Implantation and Percutaneous Coronary Intervention — The TAVI PCI Trial

doi:10.1056/nejmoa2606924

TAVI PCI

Patient / Population Intervention / Exposition Comparaison Critère de jugement

In 986 patients with severe aortic stenosis and coronary disease, PCI after TAVI was non-inferior to PCI before TAVI for death, myocardial infarction, revascularisation, rehospitalisation or major bleeding at 1 year.

N

986patients

Schéma

prospective, international, multicentre (Austria, France, Germany, Italy, Netherlands, Switzerland), open-label, 2-arm RCT; 1:1 PCI after TAVI vs PCI before TAVI (each within 1–45 days); non-inferiority; primary endpoint at 1 year, follow-up to 5 years

Critère

composite of all-cause death, non-fatal myocardial infarction, ischaemia-driven revascularisation, valve- or procedure-related rehospitalisation (including heart failure), or life-threatening/disabling or major bleeding at 1 year

Pertinence

2Important — l’un des piliers parmi d’autres.

Résultat22.2% vs 24.2% at 1 year — risk difference −2.0 percentage points (95% CI −7.4 to 3.4; P < 0.001 for non-inferiority). BARC 3a or worse bleeding 6.6% vs 9.7%.

Stähli BE, et al. N Engl J Med. 2026; published online 30 August. 10.1056/nejmoa2606924

Discussion et critique

Sequence, not indication: everyone got both procedures, and the question was only which comes first. Doing the valve first is not worse, and it bleeds less — 6.6% vs 9.7% — which is the practical argument, since PCI first means antiplatelet therapy running through the valve procedure. Non-inferiority with a margin wide enough to admit a 3.4-point excess, in a mean age of 82, so this licenses a preference rather than settling a mechanism.