Heart Valve and Artery Treatment Order Makes No Difference to Patient Outcomes, Study Finds

Doctors treating patients who have both a narrowed heart valve and blocked coronary arteries have long faced a practical question: which problem do you fix first? Research published in the New England Journal of Medicine and presented at the European Society of Cardiology Congress has now provided a clear answer — it doesn’t matter.

The trial compared two approaches in patients with severe aortic stenosis (a narrowing of the main valve that controls blood flow out of the heart) combined with coronary artery disease (a build-up of fatty deposits blocking the arteries that supply the heart muscle). One group received transcatheter aortic-valve implantation — known as TAVI, a procedure that replaces the valve without open-heart surgery — before percutaneous coronary intervention (PCI, a procedure that opens blocked arteries using a small balloon and often a metal stent). The other group had PCI first, then TAVI. At one year, rates of major clinical events were similar across both groups.

The finding is described in the research as noninferior — meaning the TAVI-first approach was not worse than the PCI-first approach by any meaningful margin. Both conditions are serious. Aortic stenosis affects blood flow from the heart to the rest of the body, while coronary artery disease raises the risk of heart attack.

So for patients and their care teams, the results suggest that treatment order can be decided based on individual clinical circumstances rather than a fixed rule — which may give doctors more flexibility when planning care.

The research was published by the New England Journal of Medicine (@NEJM). Neither the trial site nor any Kent-specific patient data was specified in the announcement.

Anyone with concerns about heart symptoms should contact their GP or call NHS 111. In an emergency, call 999.