☆ 4.6 Article

Clinical and Functional Outcomes Associated With Myocardial Injury After Transfemoral and Transapical Transcatheter Aortic Valve Replacement A Subanalysis From the PARTNER Trial (Placement of Aortic Transcatheter Valves)

JACC-CARDIOVASCULAR INTERVENTIONS (2015)

期刊

JACC-CARDIOVASCULAR INTERVENTIONS

卷 8, 期 11, 页码 1468-1479

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ELSEVIER SCIENCE INC

DOI: 10.1016/j.jcin.2015.06.018

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creatine kinase-myocardial band; myocardial injury; transcatheter aortic valve replacement; troponin

类别

Cardiac & Cardiovascular Systems

资金

Edwards Lifesciences
Boston Scientific
St. Jude
National Institutes of Health [K23 HL116660]
Scientific Advisory Board for Roche Diagnostics
St. Jude Medical

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OBJECTIVES This study sought to clarify the clinical and echocardiographic prognostic implication of myocardial injury after transcatheter aortic valve replacement (TAVR). BACKGROUND The clinical significance of cardiac biomarker elevation after TAVR remains unclear. METHODS Patients treated with TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) trial were divided into tertiles (T1, T2, T3) based on the difference between the values on post-procedure day 1 and the baseline values of 2 cardiac biomarkers: cardiac troponin I (Delta cTnI); and creatine kinase-myocardial band (Delta CK-MB) fraction. Patients were stratified according to their access route: transfemoral (TF) (n = 1,840) or transapical (TA) (n = 1,173). RESULTS At 30 days after TF-TAVR, patients in the highest tertile (T3) of cardiac biomarker elevation had a higher rate of all-cause mortality (Delta cTnI: T3: 5.4% vs. T1: 0.5%, p = 0.006; Delta CK-MB: T3: 5.7% vs. T1: 0.9%, p = 0.006) and cardiovascular mortality (Delta cTnI: T3: 4.9% vs. T1: 0.5%, p = 0.01; Delta CK-MB: T3: 3.9% vs. T1: 0.5%, p = 0.02). At 1 year, only patients in the highest CK-MB tertile had higher rates of all-cause (25.4% vs. 16.8%, p = 0.02) and cardiovascular (10.3% vs. 5.0%) mortality. Multivariable analysis demonstrated that greater release of cardiac biomarkers was independently associated with increased mortality in the TF population. After TA-TAVR, being in the highest tertile of cardiac biomarker elevation had no influence on clinical and echocardiographic outcomes at 30 days and 1 year. CONCLUSIONS After TF-TAVR, a greater degree of myocardial injury was associated with higher rates of 30-day all-cause and cardiovascular mortality. At 1 year, being in the highest tertile of Delta CK-MB was correlated with a higher rate of all-cause and cardiac mortality. Finally, the level of myocardial injury after TA-TAVR had no impact on clinical and echocardiographic outcomes. (C) 2015 by the American College of Cardiology Foundation.

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Myocardial Injury After Transcatheter Aortic Valve Replacement According to VARC-3 Criteria

Carlos Real, Marisa Avvedimento, Jorge Nuche, Anna Franzone, Julio Farjat-Pasos, Kim-Hoang Trinh, Robert Delarochelliere, Jean-Michel Paradis, Anthony Poulin, Eric Dumont, Dimitri Kalavrouziotis, Siamak Mohammadi, Siddartha Mengi, Giovanni Esposito, Josep Rodes-Cabau

Summary: This study aimed to determine the incidence, predictors, and clinical impact of periprocedural myocardial injury (PPMI) following transcatheter aortic valve replacement (TAVR) as defined by the recent VARC-3 criteria. The results showed that about 10% of TAVR patients were diagnosed with PPMI according to VARC-3 criteria, and baseline factors such as female sex and peripheral artery disease were independent predictors. PPMI had a negative impact on early and late survival.

JACC-CARDIOVASCULAR INTERVENTIONS (2023)