Coronary artery disease in patients undergoing transcatheter aortic valve replacement: Current evidence and future directions

Coronary artery disease (CAD) coexists frequently with aortic stenosis (AS), and the optimal management of CAD in patients undergoing transcatheter aortic valve replacement (TAVR) remains incompletely defined due to limited and heterogeneous evidence. This review aims to integrate the current evidence on the epidemiology and shared pathophysiology of CAD and AS, summarize the diagnostic algorithms for CAD in the TAVR population, and evaluates revascularization strategies with a focus on the timing of percutaneous coronary intervention relative to valve replacement. Current evidence suggests that while routine PCI in TAVR candidates for stable CAD may offer limited benefit, revascularization in patients with complex CAD or high anatomical burden may improve outcomes. This review further characterizes the incidence, proposed mechanisms, and prognostic significance of post-TAVR coronary events and outlines emerging strategies to optimize ischemic and procedural outcomes in this high-risk cohort.