Paris, France, 19−22 May 2026. The EuroPCR Course Directors have selected 3 major late-breaking trials that will be presented for the first time during EuroPCR 2026 and are set to impact practice worldwide. Among them is an individual participant data meta-analysis of 4 randomised controlled trials investigating the safety and effectiveness of coronary revascularisation in patients undergoing TAVI.
Background
Coronary artery disease (CAD) is frequently encountered in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI). Despite this, the optimal role of revascularisation with percutaneous coronary intervention (PCI) in patients undergoing TAVI is not well established. Further uncertainty relates to the most appropriate strategy for coronary lesion assessment: angiography or physiology guidance based on fractional flow reserve (FFR).
Contemporary randomised controlled trials with distinct designs have investigated the role of PCI compared with optimal medical treatment (OMT) in patients with CAD undergoing TAVI.1-4 The NOTION-3 and FAITAVI trials suggested the potential benefits of physiology-guided PCI, while neutral results were observed in ACTIVATION and the TCW trial included a surgical comparator arm.1-4
An individual participant data meta-analysis of these trials – the ARTICA (Advanced Research on TAVI and Ischemia-guided Coronary Assessment) meta-analysis – was presented by Roberto Scarsini.
The primary endpoint was major adverse cardiac events (MACE), which included all-cause death, myocardial infarction, any coronary revascularisation and stroke at 1 year. The co-primary endpoint was net adverse clinical events (NACE), defined as MACE plus major bleeding at 1 year.
Results
Key learnings
Conclusions and PCR recommendations
This meta-analysis provides the most comprehensive patient-level analysis to date concerning the role of coronary revascularisation in patients with AS and CAD undergoing TAVI. The findings may indicate a benefit of a strategy of selective, physiology-informed PCI in patients with severe aortic stenosis and CAD undergoing TAVI.
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