Why is this study important?​

• Coronary artery disease (CAD) is prevalent in patients who undergo transcatheter aortic valve replacement (TAVR).
• Routine PCI in patients undergoing TAVR remains a matter of debate, and there is a wide variation in practice.

What question was this study supposed to answer?​

To investigate the safety of deferral of PCI in patients undergoing TAVR.

What did the study show?​

• 466 patients with CAD and eligible for TAVR were randomized to routine PCI before TAVR or deferral of PCI.
• CAD was defined as either the presence of at least one stenosis of 70-99%, or at least one stenosis between 40% and 70% combined with a positive physiological measurement in a coronary artery with a minimal diameter of 2.5 mm.
• At 1-year follow-up, there was no significant difference in the primary endpoint of death, MI, stroke, or major bleeding between patients who underwent PCI vs the deferred PCI arm. 
• There was an increased risk of major bleeding in the PCI arm compared with the deferral arm (14.8% vs 6.2%). 
• Subsequent revascularizations were higher in the deferral arm compared with the PCI arm.

Key takeaways

• In the PRO-TAVI study, deferral of PCI was non-inferior to routine PCI in patients undergoing TAVR.
• There was a significant reduction in major bleeding in the deferral group as compared with patients in the PCI group.