For patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), the optimal strategy for managing intermediate coronary lesions remains a common clinical consideration. In European Heart Journal, a multicenter, open-label, randomized superiority trial compared fractional flow reserve (FFR)-guided versus angiography-guided percutaneous coronary intervention (PCI) in patients undergoing TAVI. The study randomized 320 patients across 15 Italian centers and included all participants in the primary analysis according to the intention-to-treat principle.

The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 12 months, defined as a composite of all-cause death, myocardial infarction, ischemia-driven target vessel revascularization, disabling stroke, or major bleeding. At 12 months, MACCE occurred in 8.5% of patients assigned to FFR-guided PCI compared with 16.0% in the angiography-guided group, corresponding to a hazard ratio of 0.52 (95% confidence interval, 0.27-0.99; P = 0.047). The difference in the primary endpoint was primarily driven by a lower rate of all-cause mortality (hazard ratio, 0.31; 95% confidence interval, 0.10-0.96). Other components of the composite endpoint were numerically lower with FFR guidance but did not reach statistical significance.

These findings indicate that FFR-guided PCI was associated with fewer adverse events at 12 months in patients undergoing TAVI with intermediate coronary lesions.