Transfemoral TAVI With or Without Coronary Angiogram in Patients With Severe Aortic Stenosis (PURE TAVI)

This study will be conducted in patients with severe aortic stenosis who are referred for transcatheter aortic valve implantation (TAVI). TAVI is the recommended treatment for severe aortic stenosis. Currently, before undergoing TAVI, most patients undergo a coronary angiography to check whether the coronary arteries are blocked and to assist in appropriate valve sizing. If significant blockages are detected, they are treated before or during TAVI. However, many patients who undergo TAVI are older and often have additional cardiovascular conditions such as hypertension, diabetes, or obesity. These comorbidities increase the risk of complications related to coronary angiography, including kidney injury from contrast dye, bleeding, and vascular complications at the access site. As such, it remains uncertain whether routine coronary angiography is necessary for all patients undergoing TAVI, particularly those without symptoms suggestive of myocardial ischemia. This study aims to determine whether a TAVI treatment pathway without prior coronary angiography is non-inferior to the standard pathway that includes routine coronary angiography, with or without revascularization, in patients with severe aortic stenosis who do not have typical angina symptoms (defined as Canadian Cardiovascular Society Class \

Inclusion Criteria: * Patient is older than 18 years with severe AS considered for TAVI by a multidisciplinary heart team. * Patient is candidate for transfemoral TAVI as per local standards and current guidelines. * Patient is willing and capable to give written consent to participate to the trial and confirmed to be able to attend the expected follow up visits. Exclusion Criteria: * Patient had a coronary angiogram with or without PCI and/or coronary CT and/or CABG within last 5 years. * Left main PCI in the medical history * Patient has CCS of 3 or more. * Patient has left ventricular ejection fraction \