For decades, cardiologists treating patients with both a failing aortic valve and blocked coronary arteries followed an unquestioned sequence: fix the arteries first, then the valve. A multinational randomized trial of nearly a thousand patients, presented at the European Society of Cardiology Congress in 2026, has quietly dissolved that certainty. The TAVI PCI trial found that reversing the order — treating the valve first — produced outcomes indistinguishable from the traditional approach, and in some patients, made the second procedure unnecessary altogether. Medicine's settled answers, it