Tomography Versus Angiography for Coronary Stenoses Before Transcatheter Aortic Valve Implantation.

Coronary artery disease is common in patients undergoing transcatheter aortic valve implantation (TAVI), but the optimal preprocedural coronary assessment strategy is uncertain. We compared long-term outcomes of a computed tomography angiography (CTA)-first versus an invasive coronary angiography (ICA)-first strategy in 307 consecutive patients undergoing TAVI at a single center (ICA-first, n = 150; CTA-first, n = 157). The primary outcome was all-cause mortality. Over a median follow-up of 61.7 months, mortality did not differ between strategies (unadjusted hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.66-1.16), and assessment strategy was not an independent predictor of death after adjustment (HR 0.95, 95% CI 0.67-1.34). A CTA-first strategy avoided invasive angiography in 73% of patients, with a nonsignificant trend toward more late post-TAVI catheterization (HR 2.47, 95% CI 0.94-6.45). Pre-TAVI percutaneous coronary intervention was not associated with lower mortality, although coronary artery disease itself identified a higher-risk phenotype. In conclusion, a CTA-first strategy yielded equivalent long-term survival while sparing most patients invasive angiography, supporting its use as the default pre-TAVI coronary assessment strategy.