Clarifying the treatment-pathway effects and generalizability of FAITAVI

This commentary refers to ‘Physiology vs angiography-guided percutaneous coronary intervention in transcatheter aortic valve implantation: the FAITAVI trial’, by F.L. Ribichini et al., https://doi.org/10.1093/eurheartj/ehaf974 and the discussion piece ‘Clarifying the treatment-pathway effects and generalizability of FAITAVI’, by K. Wang et al., https://doi.org/10.1093/eurheartj/ehag365. We thank Dr Wang and colleagues for mentioning our work as a pioneering contribution to the understanding of the real need for revascularizing TAVI patients. We also thank the Editors for giving us the opportunity of further expanding some important findings of our trial. As to the first point, we tried to address the missing revascularizations in 9% of the angio-guided group, stating that the non-treated patients presented target vessels that despite being compliant with the inclusion criteria, were deemed to expose patients to more risk than benefit given the angiographic unfavourable lesion characteristics of non-LAD vessels. The assumption behind the author's question suggests the concept that any stenting would provide benefit and that therefore, preventing stenting to such patients might have negatively influenced outcome in this group. Although we respect such opinion, the results of the study prove the contrary, i.e. stenting lesions without a proof of ischaemia led to an increase in adverse events rather than a benefit,1 and therefore if any bias was introduced by the lower number of actually performed procedures in the angio-guided group, this may have further reinformed the results of the study.