IN PATIENTS with severe aortic stenosis undergoing both transcatheter aortic valve implantation (TAVI) and complex, high-risk percutaneous coronary intervention (PCI), a staged approach is associated with fewer adverse events and lower procedural risk compared to performing both procedures concomitantly.
Severe aortic stenosis frequently coexists with complex coronary artery disease, presenting a significant challenge for heart teams tasked with determining the optimal timing for intervention. While both TAVI and complex PCI are increasingly performed in older, high-risk patients, there has been little evidence to guide whether these procedures should be done together or separately. The ASCoP registry was established to address this gap, retrospectively analysing outcomes in patients with clinical indications for both TAVI and complex or high-risk PCI across 14 centres in Europe and the US.
The registry included 519 patients, of whom 363 (69.9%) underwent staged procedures and 156 (30.1%) had concomitant TAVI and PCI. After a median follow-up of 441 days, the primary endpoint-a composite of all-cause death and unplanned rehospitalisation for cardiovascular causes-occurred in 36.5% of patients, with no significant difference between the staged and concomitant groups (36.7% vs 36.1%, p=0.98). However, the secondary endpoint, which included all-cause death, stroke, acute myocardial infarction, major bleeding, major vascular complications, and unplanned revascularisation, was significantly more frequent in the concomitant group (25.8% vs 17.4%, p=0.014). Notably, major vascular complications (4.5% vs 1.9%) and major bleeding (10.9% vs 3.9%) were higher when both procedures were performed together, with the excess risk concentrated in the first 30 days post-procedure.
These findings suggest that, in clinical practice, staging TAVI and complex PCI is preferable to a concomitant strategy, as it reduces the risk of procedural complications without increasing mortality or rehospitalisation.
Reference
Montalto C et al. Outcomes of complex, high-risk percutaneous coronary intervention in patients with severe aortic stenosis: the ASCoP registry. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2025;21(8):e426-36.
