The management of patients with coronary artery disease who are undergoing transcatheter aortic valve replacement (TAVR) should be individualized based on the patient’s overall clinical condition and anatomy, according to a council perspective from ACC’s Interventional Section Leadership Council, published Dec. 5 in JACC: Cardiovascular Interventions. Stephen Ramee, MD, FACC, et al., explain that that there is no evidence proving the safety of TAVR without prior percutaneous coronary intervention (PCI) of severe coronary lesions. Since the guidelines for PCI were completed before the role of PCI in pre-TAVR patients became a clinical issue, they state that “it would be wrong to extrapolate current ACC/American Heart Association recommendations against invasive procedures in asymptomatic patients to the TAVR population when evaluating the quality of care by cardiologists or hospitals.” The Council believes it is necessary to update the recommendations since the current practice is to follow the protocol requiring all major coronary arteries with significant stenosis to undergo PCI before TAVR despite there being no current professional society recommendations. Read more on ACC.org.