THE YEARLY incidence of coronary events (CE) following TAVR is low, recent research has shown, but outcomes are worse for patients who do not undergo PCI, particularly those with self-expandable valves (SEV).
TAVR is an established treatment for severe aortic stenosis, often performed in patients with significant coronary artery disease (CAD). Managing CE post-TAVR is challenging due to anatomical and technical constraints. This study aimed to assess the incidence and clinical impact of CE in patients who have undergone TAVR, using data from the France-TAVI registry. Given the growing number of TAVR procedures worldwide, understanding CE risk and treatment effectiveness is essential for optimising patient outcomes.
A total of 64,660 patients who underwent TAVR between 2013 and 2021 were analysed, with 63.8% receiving balloon-expandable valves (BEV) and 36.2% receiving SEV. CE occurred in 11.6% of patients, corresponding to an annual incidence of 1.5%. Prior CAD and pre-existing coronary artery stenosis (>50%) were the main predictors of CE. The composite endpoint of all-cause mortality or heart failure hospitalisation was significantly lower in patients who underwent PCI compared to those who received coronary angiography alone or no intervention (79.6% vs 85.2% and 86.5%, respectively; P = 0.002). SEV recipients had higher rates of adverse outcomes compared to BEV recipients (85.8% vs 83.8%; P = 0.01). Patients admitted to a TAVR centre were more likely to undergo PCI (OR: 1.20 [95% CI: 1.01-1.42]; P = 0.04), particularly those with BEV (OR: 1.42 [95% CI: 1.18-1.71]; P = 0.002).
The study highlights the relatively low but clinically significant risk of CE after TAVR, with poorer outcomes for those who do not undergo PCI. SEV patients have a higher risk of unfavourable outcomes and reduced likelihood of PCI, especially when treated at non-TAVR centres. These findings reinforce the importance of proactive coronary assessment and the need for optimised intervention strategies in TAVR patients. Future research should focus on improving coronary access post-TAVR and identifying patient subgroups that may benefit most from early intervention, guiding best practices in clinical management.
Katrina Thornber, EMJ
Reference
Zendjebil S et al. Coronary events after transcatheter aortic valve replacement: insights from the france TAVI registry. Cardiovascular Interventions. 2025;18(2):229-43.
