87 year old male with known aortic stenosis and moderate pulmonary hypertension presented on March 19, 2018 with NSTEMI (TnI of 2.0) and acute diastolic heart failure. A Cardiac Cath on March 20, 2018 revealed 3 V CAD: 80% calcified proximal LAD/Diagonal bifurcation (Medina 1,1,1), 90% thrombotic distal LCx, 70% proximal RCA with normal LV function and SYNTAX Score of 24. Patient improved rapidly on medical therapy and a follow-up echo revealed severe AS with PG/MG/AVA/PV: 110/82/0.3/5.2. Patient is now planned for iFR guided multi-vessel PCI of LAD/D1 bifurcation, distal circumflex and BAV as prelude to planned TAVR procedure after one month.