NEW nationwide data show that PCI after TAVR remains uncommon but is rising steadily, with reassuring safety outcomes and growing implications for long term coronary management in an ageing yet increasingly younger treated population.
Why Coronary Disease Matters After TAVR
TAVR has rapidly expanded beyond high-risk surgical candidates and is now routinely offered to younger patients with longer life expectancy. As a result, management of concomitant coronary artery disease has evolved, with many centres opting for conservative treatment before valve implantation. This approach means that coronary intervention may be deferred until after TAVR, raising important questions about feasibility, safety, and access to coronary arteries through transcatheter heart valves. Understanding real world patterns of PCI after TAVR is therefore essential for guiding lifetime treatment strategies and multidisciplinary decision making.
PCI After TAVR in a National Cohort
Investigators analysed data from the Netherlands Heart Registration, identifying patients with prior TAVR who underwent PCI between January 2015 and September 2021. Among 216,813 PCI patients, 419 individuals or 0.19% had previously undergone TAVR, corresponding to an incidence of 2.81% among all TAVR patients in the Netherlands (n = 14,933). The proportion of PCI procedures after TAVR increased significantly from 0.05% in 2015 to 0.39% in 2021 (p < 0.001). Procedural adverse events were low overall. Differences emerged by valve platform, with patients treated using self-expanding transcatheter heart valves more likely to undergo PCI without stent implantation compared with balloon expandable valves (17.8% vs. 10.1%, p = 0.049). Despite this, target vessel revascularization rates and all-cause mortality were comparable. Importantly, matched patients with and without prior TAVR experienced similar clinical outcomes, supporting the procedural safety of PCI after TAVR, even when performed for urgent indications such as NSTEMI.
Implications For Clinical Practice and Future Care
The findings confirm that PCI after TAVR is safe but increasingly relevant as TAVR indications expand. For clinicians, coronary access must be considered at the time of valve selection and procedural planning. Ongoing randomised trials will help refine optimal timing and revascularization strategies, but heart teams should already integrate lifetime coronary management into TAVR decision making.
Reference
Aarts HM et al. Transcatheter heart intervention and percutaneous coronary intervention registration committees of the Netherlands Heart Registration. Nationwide analysis of PCI after TAVR from the Netherlands Heart Registration. Catheterization and Cardiovascular Interventions. 2025;DOI:10.1002/ccd.70428.
