ARTICA: Coronary revascularisation in patients undergoing TAVI - an individual patient data meta-analysis of 4 randomised trials

Major LBTs from EuroPCR 2026

Summary

At EuroPCR 2026, Martin Leon and Roberto Scarsini review ARTICA, a patient-level meta-analysis combining data from the ACTIVATION, NOTION-3, FAITAVI, and TCW randomised trials.

The analysis included 1,050 patients with severe aortic stenosis and concomitant coronary artery disease and compared three management strategies: medical therapy, angiography-guided PCI, and FFR-guided PCI.

At 1 year, PCI was associated with a lower rate of MACE compared with conservative management. Among the different strategies, FFR-guided PCI demonstrated the greatest benefit, highlighting the potential value of physiological assessment in this challenging population.

Beyond the results themselves, the discussion explores a practical algorithm for managing patients with severe AS and CAD, while addressing key questions surrounding patient selection, timing of revascularisation, and the role of physiology-guided treatment strategies in contemporary TAVI practice.

This interview was filmed at EuroPCR 2026: see more videos here.

“Despite the high burden of CAD in patients referred for TAVI, optimal management remains uncertain,” noted the first presenter, Roberto Scarsini (University of Verona - Verona, Italy). “Contemporary trials with distinct designs, endpoints and inclusion criteria have investigated the role of PCI vs. optimal medical treatment (OMT) in patients with CAD undergoing TAVI. However, interpretation is hindered by limited sample sizes and methodological heterogeneity. To address this knowledge gap, we conducted the ARTICA meta-analysis in which we identified four key RCTs – NOTION-3, ACTIVATION, TCW and FAITAVI – and analysed individual participant data from these trials.”

The primary endpoint was major adverse cardiovascular events (MACE), which included all-cause death, MI, any coronary revascularisation and stroke at 1 year. The co-primary endpoint was net adverse clinical events (NACE), defined as MACE plus major bleeding at 1 year.

Data from 1,050 patients were combined and stratified in three groups: FFR-guided PCI (n=439), angiography-guided PCI (n=255) and OMT (n=356). The mean age was around 83 years and approximately 36% were female.

Overall, PCI was associated with lower risk of MACE at 1 year compared with OMT (8.4% vs. 14.3%; hazard ratio [HR] 0.70; 95% CI 0.49–0.99; p=0.049).

The lower incidence of MACE was driven by a lower risk of any revascularisation (0.7% vs. 4.5%; HR 0.34; 95% CI 0.14–0.80). Other individual components of the primary endpoint were similar in both groups. The risk of NACE was also similar (HR 1.01; 95% CI 0.74–1.38), with no significant difference in the incidence of major bleeding for PCI vs. OMT (10.2% vs. 12.6%; HR 1.21; 95% CI 0.81–1.82).

FFR-guided PCI demonstrated a lower risk of MACE (HR 0.58; 95% CI 0.37–0.91) and NACE (HR 0.68; 95% CI 0.50–0.90) compared with OMT. No significant differences in MACE or NACE were observed between angiography-guided PCI and OMT.

Major bleeding occurred in 8.2% of patients with FFR-guided PCI, 13.7% with angiography-guided PCI and 12.6% with OMT.

Dr Scarsini concluded: “Routine PCI provides limited advantage compared with OMT. Physiology-guided PCI may improve the outcome of patients with CAD undergoing TAVI.”

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