Highlights
– In the international, multicentre TCW trial (n=172; mean age 76.5 years), FFR-guided PCI plus TAVI met the prespecified non-inferiority margin versus conventional SAVR plus CABG for a composite 1‑year outcome and was superior (hazard ratio 0.17; 95% CI 0.06–0.51; psuperiority<0.001).
– The superior outcome was driven mainly by lower all‑cause mortality (0% vs 10%; p=0.0025) and reduced life‑threatening or disabling bleeding (2% vs 12%; p=0.010) with the percutaneous strategy.
– These findings challenge the established paradigm that combined SAVR + CABG is uniformly preferred in patients with severe aortic stenosis and complex multivessel coronary disease, suggesting a less invasive approach can be effective in selected patients.
