The following is the summary of “Routine revascularization with percutaneous coronary intervention in patients with coronary artery disease undergoing transcatheter aortic valve implantation – the third nordic aortic valve intervention trial – NOTION-3” published in the January 2023 issue of American Heart Journal by Sabbah, et al.

Patients scheduled for transcatheter aortic valve implantation often have both severe aortic valve stenosis (AS) and coronary artery disease (CAD) transcatheter aortic valve implantation (TAVI). There is still no consensus on how to treat CAD in this patient group. More specifically, the question of whether or not percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) is more effective than medical treatment for coronary artery disease (CAD) remains unanswered. 

It is anticipated that 452 patients with severe AS and significant CAD will be randomly assigned to receive either FFR-guided percutaneous coronary intervention (PCI) or medical treatment in addition to TAVI in the third Nordic aortic valve intervention (NOTION-3) Trial, an open-label investigator-initiated multicenter, multinational trial. Participation in the trial is contingent upon at least one substantial coronary stenosis that is amenable to percutaneous coronary intervention. A fractional flow reserve (FFR) of  ≤0.80 or a stenosis diameter of >90% is considered clinically significant. Until all patients have been followed for 1 year after TAVI. 

The primary endpoint is a combination of the first occurrence of all-cause mortality, myocardial infarction, or urgent revascularization (percutaneous coronary intervention or coronary artery bypass graft performed during unplanned hospital admission). Patients with severe AS who are scheduled to undergo TAVI are the focus of NOTION-3, a multicenter, international randomized trial that will compare FFR-guided revascularization to medical therapy of CAD.