Assessment of Coronary Artery Disease Before Transcatheter Aortic Valve Replacement: A Randomized, Multicenter, Non-Inferiority Trial

NCT ID: NCT07107568

Last Updated: 2025-08-22

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

700 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-08-14

Study Completion Date

2029-12-31

Brief Summary

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The goal of this clinical trial is to determine whether a non-invasive coronary assessment strategy using photon-counting detector computed tomography (PCD-CT) is non-inferior to invasive coronary angiography (ICA) for evaluating coronary artery disease (CAD) prior to transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis.

Detailed Description

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The goal of this randomized, multicenter trial is to assess the safety and efficacy of a non-invasive diagnostic strategy using photon-counting detector computed tomography (PCD-CT) for the assessment of coronary artery disease (CAD) prior to transcatheter aortic valve replacement (TAVR), compared to the current standard of care using invasive coronary angiography (ICA).

The trial evaluates the hypothesis that a PCD-CT-guided strategy is non-inferior to routine ICA with respect to the risk of major adverse cardiovascular events (MACE) at 12 months. MACE is defined as a composite of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, urgent revascularization, or bleeding.

Conditions

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Aortic Valve Stenosis and Insufficiency Coronary Artery Disease(CAD) Transcatheter Aortic Valve Replacement (TAVR)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized, controlled, multicenter, open-label, parallel-group, two-arm non-inferiority trial. Participants are assigned in a 1:1 ratio to either a PCD-CT-guided diagnostic strategy or standard invasive coronary angiography prior to TAVR evaluation.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

SINGLE

Outcome Assessors
An independent, blinded Clinical Events Committee will adjudicate all primary and key secondary endpoints based on medical records. The committee members will not be informed of the participants' group allocation (PCD-CT vs. ICA). The statistical analysis will also be conducted by an independent statistician blinded to treatment assignment.

Study Groups

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PCD-CT-Guided Diagnostic Strategy

Participants randomized to this arm will undergo coronary artery disease (CAD) assessment using photon-counting detector computed tomography (PCD-CT). Invasive coronary angiography (ICA) will only be performed if PCD-CT shows significant CAD, defined as ≥70% diameter stenosis in vessels ≥2.5 mm or ≥50% in the left main artery.

Group Type EXPERIMENTAL

PCD-CT-Guided Diagnostic Strategy

Intervention Type DIAGNOSTIC_TEST

Participants randomized to this arm will undergo coronary artery disease (CAD) assessment using photon-counting detector computed tomography (PCD-CT). Invasive coronary angiography (ICA) will only be performed if PCD-CT shows significant CAD, defined as ≥70% diameter stenosis in vessels ≥2.5 mm or ≥50% in the left main artery.

Standard Invasive Coronary Angiography

Participants randomized to this arm will undergo routine invasive coronary angiography (ICA) as the standard of care for pre-TAVR assessment of coronary artery disease.

Group Type ACTIVE_COMPARATOR

Standard Invasive Coronary Angiography

Intervention Type DIAGNOSTIC_TEST

Standard invasive coronary angiography performed routinely for all participants in this arm to assess coronary artery disease before TAVR.

Interventions

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Standard Invasive Coronary Angiography

Standard invasive coronary angiography performed routinely for all participants in this arm to assess coronary artery disease before TAVR.

Intervention Type DIAGNOSTIC_TEST

PCD-CT-Guided Diagnostic Strategy

Participants randomized to this arm will undergo coronary artery disease (CAD) assessment using photon-counting detector computed tomography (PCD-CT). Invasive coronary angiography (ICA) will only be performed if PCD-CT shows significant CAD, defined as ≥70% diameter stenosis in vessels ≥2.5 mm or ≥50% in the left main artery.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 18 years
* Severe aortic valve stenosis and indication for intervention according to current European Society of Cardiology (ESC) guidelines
* TAVR candidate
* Written informed consent

Exclusion Criteria

* Cardiogenic shock at presentation (e.g., emergency indication for TAVR)
* Severe renal impairment with an estimated glomerular filtration rate of \<30 mL/min/1.73 m²
* Life expectancy \<1 year due to other severe non-cardiac disease (e.g., malignancy)
* Pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical University Innsbruck

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sebastian J Reinstadler, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Medical University of Innsbruck

Martin Reindl, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Medical University of Innsbruck

Locations

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Medical University of Innsbruck

Innsbruck, , Austria

Site Status RECRUITING

Countries

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Austria

Central Contacts

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Sebastian J Reinstadler, MD, PhD

Role: CONTACT

+43 512 504 25665

Ivan Lechner, MD, PhD

Role: CONTACT

+43 512 504 25665

Facility Contacts

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Sebastian J Reinstadler, MD, PhD

Role: primary

+43 512 504 25665

Other Identifiers

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1124/2025

Identifier Type: -

Identifier Source: org_study_id

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