With the use of transcatheter aortic valve implantation (TAVI) increasing over the past decade, studies focused on strategies to optimize TAVI outcomes have gained precedence [ ]. An important clinical question is often regarding the optimal treatment strategy of severe coronary artery disease (CAD) in patients planned for TAVI. Conservative, pre- and concomitant revascularization with percutaneous coronary intervention (PCI) with TAVI has been studied, with comparable results between all three strategies [ , ]. However, most of the evidence to date stems from observational studies, and as such has been limited by confounding that is only partially addressed considering the limitations of the databases used. The ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter aortic VAlve implantaTION) trial reported similar rates of 1-year death and re-hospitalization in TAVI patients with Canadian Cardiovascular Society class ≤2 angina in patients who underwent prior PCI compared with no PCI; however, PCI was associated with higher major bleeding [ ]. The limitation of this trial was a small randomized sample giving rise to the possibility of a Type 2 error in the results.