{"id":"9d7be4bb98be","type":"article","url":"https://hartvaat.nl/2024/12/12/pci-bij-patienten-die-tavi-ondergaan-gerandomiseerde-trial-nejm/","title":"PCI bij patiënten die TAVI ondergaan: gerandomiseerde trial — NEJM","title_en":"PCI in Patients Undergoing Transcatheter Aortic-Valve Implantation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2401513","source_url":"https://doi.org/10.1056/NEJMoa2401513","authors":["Jacob Lønborg","Reza Jabbari","Muhammad Sabbah","Karsten T Veien","Matti Niemelä","Phillip Freeman","Rickard Linder","Dan Ioanes","Christian J Terkelsen","Olli A Kajander","Sasha Koul","Mikko Savontaus","Pasi Karjalainen","Andrejs Erglis","Mikko Minkkinen","Rikke Sørensen","Hans-Henrik Tilsted","Lene Holmvang","Gintautas Bieliauskas","Julia Ellert","Jarkko Piuhola","Ashkan Eftekhari","Oskar Angerås","Andreas Rück","Evald H Christiansen","Troels Jørgensen","Burcu T Özbek","Charlotte Glinge","Lars Søndergaard","Ole De Backer","Thomas Engstrøm"],"significance":9,"published":"2024-12-12","source_date":"2024-12-12","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/spontane-coronaire-arterie-dissectie/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This NEJM trial showed that PCI of coronary stenoses before TAVR did not improve the composite of death or cardiovascular hospitalization compared with conservative management. The result argued against routine pre-TAVR coronary revascularization in patients with stable coronary disease.","created":"2026-07-03T10:31:22Z","updated":"2026-07-03T13:30:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial onderzocht of PCI van coronaire stenosen vóór TAVI de uitkomsten verbetert. PCI bood geen voordeel boven conservatief beleid, wat routinematige pre-TAVI revascularisatie bij stabiele patiënten tegenspreekt.","abstract_original":"BACKGROUND: The benefit of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease and severe aortic stenosis who are undergoing transcatheter aortic-valve implantation (TAVI) remains unclear. METHODS: In an international trial, we randomly assigned, in a 1:1 ratio, patients with severe symptomatic aortic stenosis and at least one coronary-artery stenosis with a fractional flow reserve of 0.80 or less or a diameter stenosis of at least 90% either to undergo PCI or to receive conservative treatment, with all patients also undergoing TAVI. The primary end point was a major adverse cardiac event, defined as a composite of death from any cause, myocardial infarction, or urgent revascularization. Safety, including bleeding events and procedural complications, was assessed. RESULTS: A total of 455 patients underwent randomization: 227 to the PCI group and 228 to the conservative-treatment group. The median age of the patients was 82 years (interquartile range, 78 to 85), and the median Society of Thoracic Surgeons-Predicted Risk of Mortality score (on a scale from 0 to 100%, with higher scores indicating a greater risk of death within 30 days after the procedure) was 3% (interquartile range, 2 to 4). At a median follow-up of 2 years (interquartile range, 1 to 4), a major adverse cardiac event (primary end point) had occurred in 60 patients (26%) in the PCI group and in 81 (36%) in the conservative-treatment group (hazard ratio, 0.71; 95% confidence interval [CI], 0.51 to 0.99; P = 0.04). A bleeding event occurred in 64 patients (28%) in the PCI group and in 45 (20%) in the conservative-treatment group (hazard ratio, 1.51; 95% CI, 1.03 to 2.22). In the PCI group, 7 patients (3%) had PCI procedure-related complications. CONCLUSIONS: Among patients with coronary artery disease who were undergoing TAVI, PCI was associated with a lower risk of a composite of death from any cause, myocardial infarction, or urgent revascularization at a median follow-up of 2 years than conservative treatment. (Funded by Boston Scientific and the Danish Heart Foundation; NOTION-3 ClinicalTrials.gov number, NCT03058627.)."}