Similarly, there is an argument to be made for coronary revascularization among patients un- dergoing TAVI, although the effects on late outcomes are less well defined and may not be the same as for SAVR, given the different demographics and comorbid- ities of the TAVI versus SAVR populations. Nonetheless, at this point, diagnostic imaging and consideration of revascularization are appropriate (Figure 19). Recommendation-Specific Supportive Text 1. The prevalence of CAD in patients with severe AS ranges between 15% and 80%.5 and varies depending on the definition of CAD used and the The impact of CAD on outcomes is controversial,7,8 although one report CLINICAL STATEMENTS AND GUIDELINES singled out severe CAD (defined by a SYNTAX score >22) and incomplete revascularization as the only independent predictors of death after TAVI.9 Assessment of the coronary anatomy is important in patients with severe AS to rule out obstructive CAD. Invasive coronary angiography is commonly performed. In patients with a low pretest prob- ability of CAD, contrast-enhanced coronary CT has an excellent negative predictive In patients with normal renal function, an option is to combine contrast-enhanced coro- nary CT angiography with CT assessment of the peripheral circulation and heart structure as an ini- tial imaging test, reserving coronary angiography for the event that the contrast-enhanced coronary CT angiography is nondiagnostic or significant CAD is found. Invasive functional assessment of coronary lesions in TAVI candidates by using frac- tional flow reserve or instantaneous wave-free ratio is safe and feasible.13 15 Instantaneous wave- free ratio may be particularly attractive because it does not require the administration of a vaso- dilator and is less influenced by the effect of the stenotic aortic valve, although randomized clinical trials validating the utility of both are ongoing. 2. 