Staged Complete Revascularization for Coronary Artery Disease vs Medical Management Alone in Patients With AS Undergoing Transcatheter Aortic Valve Replacement

NCT ID: NCT04634240

Last Updated: 2025-07-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

4000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-12-19

Study Completion Date

2026-04-01

Brief Summary

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Patients undergoing transcatheter aortic valve replacement (TAVR) often have concomitant coronary artery disease (CAD) which may adversely affect prognosis. There is uncertainty about the benefits and the optimal timing of revascularization for such patients. There is currently clinical equipoise regarding the management of concomitant CAD in patients undergoing TAVR. Some centers perform routine revascularization with percutaneous coronary intervention (PCI) (either before or after TAVR), while others follow an alternative strategy of medical management.

The potential benefits and optimal timing of PCI in these patients are unknown. As TAVR expands to lower risk patients, and potentially becomes the preferred therapy for the majority of patients with severe aortic stenosis, the optimal management of concomitant coronary artery disease will be of increasing importance.

The COMPLETE TAVR study will determine whether, on a background of guideline-directed medical therapy, a strategy of complete revascularization involving staged PCI using drug eluting stents to treat all suitable coronary artery lesions is superior to a strategy of medical therapy alone in reducing the composite outcome of Cardiovascular Death, new Myocardial Infarction, Ischemia-driven Revascularization or Hospitalization for Unstable Angina or Heart Failure.

The study will be a randomized, multicenter, open-label trial with blinded adjudication of outcomes. Patients will be screened and consented for elective transfemoral TAVR and randomized within 96 hours of successful balloon expandable TAVR.

Complete Revascularization:

Staged PCI using third generation drug eluting stents to treat all suitable coronary artery lesions in vessels that are at least 2.5 mm in diameter and that are amenable to treatment with PCI and have a ≥70% visual angiographic diameter stenosis. Staged PCI can occur any time from 1 to 45 days post successful transfemoral TAVR.

Vs. Medical Therapy Alone:

No further revascularization of coronary artery lesions.

All patients, regardless of randomized treatment allocation, will receive guideline-directed medical therapy consisting of risk factor modification and use of evidence-based therapies. The COMPLETE TAVR study will help address the current lack of evidence in this area. It will likely impact both the global delivery of health care and the management and clinical outcomes of all patients undergoing TAVR with concomitant CAD.

Detailed Description

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Conditions

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Aortic Stenosis Coronary Artery Disease Coronary Stenosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Complete Revascularization

Routine PCI (percutaneous coronary intervention) of all suitable coronary artery stenoses of ≥70% in vessels ≥2.5mm in diameter.

Group Type EXPERIMENTAL

Percutaneous Coronary Intervention (PCI)

Intervention Type PROCEDURE

PCI of all qualifying lesions.

Medical Therapy Alone

No revascularization of coronary artery lesions.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Percutaneous Coronary Intervention (PCI)

PCI of all qualifying lesions.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

\- Symptomatic aortic valve stenosis prior to TAVR (NYHA Functional Class ≥ 2 OR Abnormal exercise test with severe SOB, abnormal BP response, or arrhythmia)

AND

\- CAD defined as: at least 1 coronary artery lesion of ≥70% visual angiographic diameter stenosis in a native segment ≥2.5 mm in diameter that is not a CTO and is amenable to treatment with PCI

AND

\- Consensus by the Local Multidisciplinary Heart Team that the patient is suitable for elective transfemoral TAVR with a balloon expandable transcatheter heart valve AND would receive a bypass with an anastomosis distal to the coronary artery lesion(s) if they were undergoing SAVR.

Local Multidisciplinary Heart Teams are expected to follow current clinical guidelines for selection of patients for TAVR with an eligible patient generally expected to have:

\[AVA ≤ 1.0 cm2 OR AVA index ≤ 0.6 cm2/m2\]

OR

\[Jet velocity ≥ 4.0 m/s OR mean gradient ≥ 40 mmHg\]

OR

patients without these criteria may undergo TAVR if the Local Multidisciplinary Heart Team concludes it is appropriate.

AND

\- Successful transfemoral TAVR, defined as the implantation of a single transcatheter aortic valve within the past 96 hours with freedom from more than minimal aortic insufficiency, stroke, or major vascular complications.

Exclusion Criteria

* PCI already performed within 90 days prior to TAVR or at the same time as the index transfemoral TAVR procedure
* Planned PCI of coronary artery lesion(s)
* Planned surgical revascularization of coronary artery lesion(s)
* Non-cardiovascular co-morbidity reducing life expectancy to \< 5 years
* Any factor precluding 5-year follow-up
* Prior coronary artery bypass grafting surgery or surgical valve replacement
* Severe mitral regurgitation (\> 3+)
* Severe left ventricular dysfunction (LVEF \< 30%)
* Low coronary takeoff (high risk for coronary obstruction)
* Acute myocardial infarction within 90 days
* Stroke or transient ischemic attack within 90 days
* Renal insufficiency (eGFR \< 30 ml/min) and/or renal replacement Rx
* Hemodynamic or respiratory instability
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of British Columbia

OTHER

Sponsor Role lead

Responsible Party

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David Wood

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David A Wood, MD

Role: PRINCIPAL_INVESTIGATOR

CCI-CIC, University of British Columbia

Locations

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Huntsville Heart Center

Huntsville, Alabama, United States

Site Status RECRUITING

Arizona Cardiovascular Research

Phoenix, Arizona, United States

Site Status RECRUITING

Veteran Affairs Palo Alto Health Care System

Palo Alto, California, United States

Site Status RECRUITING

Loma Linda University

Redlands, California, United States

Site Status RECRUITING

Santa Barbara Cottage Hospital

Santa Barbara, California, United States

Site Status RECRUITING

Torrance Memorial Medical Center

Torrance, California, United States

Site Status RECRUITING

JFK Medical Center

Atlantis, Florida, United States

Site Status RECRUITING

Baptist Health Jacksonville

Jacksonville, Florida, United States

Site Status RECRUITING

Miami Cardiac and Vascular/Baptist Hospital

Miami, Florida, United States

Site Status RECRUITING

Piedmont

Atlanta, Georgia, United States

Site Status RECRUITING

Northeast Georgia Health System

Gainesville, Georgia, United States

Site Status RECRUITING

St. Alphonsus Regional Medical Center

Boise, Idaho, United States

Site Status RECRUITING

Ascension Alexian Brothers

Chicago, Illinois, United States

Site Status RECRUITING

Midwest Cardiovascular Research and Education Foundation

Elkhart, Indiana, United States

Site Status RECRUITING

Parkview Research Center

Fort Wayne, Indiana, United States

Site Status RECRUITING

University of Kansas Medical Center

Kansas City, Kansas, United States

Site Status RECRUITING

Midwest Heart and Vascular

Overland Park, Kansas, United States

Site Status RECRUITING

Cardiovascular Research Institute of Kansas

Wichita, Kansas, United States

Site Status RECRUITING

Tufts Medical

Boston, Massachusetts, United States

Site Status RECRUITING

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status RECRUITING

Sparrow Clinical Research Institute

Lansing, Michigan, United States

Site Status RECRUITING

William Beaumont Hospital

Royal Oak, Michigan, United States

Site Status RECRUITING

Ascension St. Mary's

Saginaw, Michigan, United States

Site Status RECRUITING

St. Joseph Mercy Health System

Ypsilanti, Michigan, United States

Site Status RECRUITING

University of Minnesota Medical Center

Minneapolis, Minnesota, United States

Site Status RECRUITING

CentraCare Heart and Vascular Center

Saint Cloud, Minnesota, United States

Site Status RECRUITING

Boone Hospital

Columbia, Missouri, United States

Site Status RECRUITING

St. Louis University

St Louis, Missouri, United States

Site Status RECRUITING

Missouri Baptist

St Louis, Missouri, United States

Site Status RECRUITING

Bryan Heart

Lincoln, Nebraska, United States

Site Status RECRUITING

Dartmouth Hitchcock Medical Center

Lebanon, New Hampshire, United States

Site Status RECRUITING

Our Lady of Lourdes

Camden, New Jersey, United States

Site Status RECRUITING

Valley Hospital

Ridgewood, New Jersey, United States

Site Status RECRUITING

University at Buffalo

Buffalo, New York, United States

Site Status RECRUITING

NYU Langone Hospital - Long Island

Mineola, New York, United States

Site Status RECRUITING

Mount Sinai

New York, New York, United States

Site Status RECRUITING

Columbia University Medical Center

New York, New York, United States

Site Status RECRUITING

St. Joseph's Hospital

Syracuse, New York, United States

Site Status RECRUITING

Montefiore Medical Center

The Bronx, New York, United States

Site Status RECRUITING

Novant Health Heart and Vascular Institute

Charlotte, North Carolina, United States

Site Status RECRUITING

Summa Health System

Akron, Ohio, United States

Site Status RECRUITING

Mount Carmel

Columbus, Ohio, United States

Site Status RECRUITING

Oklahoma Heart

Oklahoma City, Oklahoma, United States

Site Status RECRUITING

Kaiser Permanente Northwest

Clackamas, Oregon, United States

Site Status RECRUITING

Rhode Island Hospital

Providence, Rhode Island, United States

Site Status RECRUITING

Methodist Le Bonheur Healthcare

Germantown, Tennessee, United States

Site Status RECRUITING

Ballad Health CVA Heart Institute

Kingsport, Tennessee, United States

Site Status RECRUITING

Parkwest Medical Center

Knoxville, Tennessee, United States

Site Status RECRUITING

Cardiovascular Surgery Clinic/Baptist Memorial

Memphis, Tennessee, United States

Site Status RECRUITING

HCA Houston Healthcare Medical Center

Houston, Texas, United States

Site Status RECRUITING

Baylor Scott & White Plano

Plano, Texas, United States

Site Status RECRUITING

Baylor Scott & White Round Rock

Round Rock, Texas, United States

Site Status RECRUITING

University of Vermont Medical Center

Burlington, Vermont, United States

Site Status RECRUITING

Bellin Health System

Green Bay, Wisconsin, United States

Site Status RECRUITING

Ascension Columbia St. Mary's

Milwaukee, Wisconsin, United States

Site Status RECRUITING

University of Alberta, Mazankowski Heart Institute

Edmonton, Alberta, Canada

Site Status RECRUITING

Royal Columbian Hospital

New Westminster, British Columbia, Canada

Site Status RECRUITING

Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status RECRUITING

Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire (CCI-CIC)

Vancouver, British Columbia, Canada

Site Status NOT_YET_RECRUITING

St. Paul's Hospital

Vancouver, British Columbia, Canada

Site Status RECRUITING

Saint Boniface

Winnipeg, Manitoba, Canada

Site Status RECRUITING

New Brunswick Heart

Saint John, New Brunswick, Canada

Site Status RECRUITING

Queen Elizabeth II Health Sciences Centre

Halifax, Nova Scotia, Canada

Site Status RECRUITING

Hamilton Health Sciences

Hamilton, Ontario, Canada

Site Status RECRUITING

Ottawa Heart

Ottawa, Ontario, Canada

Site Status RECRUITING

Sunnybrook Hospital

Toronto, Ontario, Canada

Site Status RECRUITING

St. Michael's Hospital

Toronto, Ontario, Canada

Site Status RECRUITING

Montréal Heart

Montreal, Quebec, Canada

Site Status RECRUITING

Centre Hospitalier de l'Université de Montréal

Montreal, Quebec, Canada

Site Status RECRUITING

Sacré-Coeur

Montreal, Quebec, Canada

Site Status RECRUITING

CIUSSS de l'Estrie-CHUS

Sherbrooke, Quebec, Canada

Site Status RECRUITING

Prairie Vascular

Regina, Saskatchewan, Canada

Site Status RECRUITING

Countries

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United States Canada

Central Contacts

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Brady J Robinson, CCRP

Role: CONTACT

604-875-4111 ext. 22936

Facility Contacts

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Alex Vasquez, MD

Role: primary

Hursh Naik, MD

Role: primary

Celina Yong, MD

Role: primary

Ken Jutzy, MD

Role: primary

Michael Shenoda, MD

Role: primary

Salman Azam, MD

Role: primary

Mark Rothenberg, MD

Role: primary

Sidd Wayangankar, MD

Role: primary

Ramon Quesada

Role: primary

Pradeep Yadav, MD

Role: primary

Ronnie Ramadan

Role: primary

Joseph Walsh, MD

Role: primary

Andrei Pop, MD

Role: primary

Troy Weirick, MD

Role: primary

Roy W Robertson, MD

Role: primary

Peter Tadros, MD

Role: primary

Bangalore Deepak, MD

Role: primary

Bassem Chehab, MD

Role: primary

Charles Resor, MD

Role: primary

Nilay Patel, MD

Role: primary

Mohammad Qintar, MD

Role: primary

Amr Abbas, MD

Role: primary

Safwan Kassas, MD

Role: primary

Mansoor A Qureshi, MD

Role: primary

Gregory Helmer, MD

Role: primary

Thom Dahle, MD

Role: primary

Joss Fernandez, MD

Role: primary

Kishore Harjai, MD

Role: primary

Gus Theodos, MD

Role: primary

Matthew Johnson, MD

Role: primary

James DeVries, MD

Role: primary

Ibrahim Moussa, MD

Role: primary

Raj Tayal, MD

Role: primary

Vijay Iyer, MD

Role: primary

Richard Schwartz, DO

Role: primary

Samin Sharma, MD

Role: primary

Vivian Ng, MD

Role: primary

Ayman Iskander, MD

Role: primary

Mark Menegus, MD

Role: primary

Oluseun Alli, MD

Role: primary

Peter Bittenbender, MD

Role: primary

Noah Jones, MD

Role: primary

Mohammad Ghani, MD

Role: primary

Abhimanyu Uberoi

Role: primary

Paul Gordon, MD

Role: primary

Mehul Patel, MD

Role: primary

Mark Aziz, MD

Role: primary

Ayaz Rahman, MD

Role: primary

Basil Paulus, MD

Role: primary

Pranav Loyalka, MD

Role: primary

Srini Potluri, MD

Role: primary

Jose Condado, MD

Role: primary

Tanush Gupta, MD

Role: primary

Jason Ricci

Role: primary

Brad Stair, MD

Role: primary

Robert Welsh, MD

Role: primary

Albert Chan, MD

Role: primary

Jackie Chow

Role: primary

604-875-5324

Brady J Robinson, CCRP

Role: primary

604-875-4111 ext. 22936

Elizabeth Grieve

Role: primary

604-682-2344 ext. 64980

Malek Kass, MD

Role: primary

Brent McGrath, MD

Role: primary

Osama ElKhateeb, MD

Role: primary

Tej Sheth, MD

Role: primary

Sandy Dick, MD

Role: primary

Sam Radhakrishnan

Role: primary

Neil Fam, MD

Role: primary

Anita Asgar, MD

Role: primary

Jean Bernard Masson

Role: primary

Rémi Kouz, MD

Role: primary

Benoit Daneault, MD

Role: primary

Payam Dehghani, MD

Role: primary

Other Identifiers

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H20-00968

Identifier Type: -

Identifier Source: org_study_id

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