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February 6, 2026European Heart Journal

Incidence and prognostic impact of periprocedural myocardial injury during transcatheter aortic valve implantation

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Why the study?

Data are conflicting regarding the importance of periprocedural myocardial injury during TAVI and its clinical impact, while standard sensitivity troponin assays recommended by VARC 3 are increasingly unavailable.

Does periprocedural myocardial injury assessed by high-sensitivity troponin I impact 1-year mortality in patients undergoing transfemoral TAVI?

Population

898 patients with severe aortic stenosis treated with transfemoral TAVI

Comparison

Different myocardial injury definitions and postprocedural hs-cTnI quartiles

Design

Observational cohort study

Follow-up

1-year

Key result

Periprocedural myocardial injury assessed by hs-cTnI is common after TAVI but not consistently associated with increased 1-year mortality, despite a higher risk in the 3rd quartile (HR 1.93; p=0.036).

Authors

LWLara WaldschmidtSLS LudwigIHIna von der Heide

Discussion

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Overview

hs-cTnI injury after TAVI is common but not consistently linked to 1-year mortality; leaves open whether standardized definitions improve risk stratification.

Key Points

  • This study aims to assess the incidence and outcomes of periprocedural myocardial injury during transcatheter aortic valve implantation using high-sensitivity troponin I assays.
  • Analyzed 898 patients with severe aortic stenosis treated with transfemoral TAVI from 2021 to 2023
  • Measured preoperative and postprocedural troponin levels using high-sensitivity cardiac troponin I assay
  • Calculated incidence of myocardial injury based on various definitions
  • Performed uni- and multivariate regression to identify predictors of troponin elevation
  • Utilized Kaplan-Meier curves and Cox proportional hazards models to evaluate mortality risks associated with troponin levels.
  • 96.5% of patients met criteria for simple myocardial injury
  • 59.9% experienced major myocardial injury
  • 7.0% satisfied SCAI criteria for myocardial injury
  • Median postoperative troponin level was 285 ng/L with significant change from preoperative basal values
  • No significant difference in all-cause mortality among MI definitions, but higher risk of death was associated with specific postoperative troponin quartiles.

Study Design

Type

Cohort (n=898)

Structured PICO

Does periprocedural myocardial injury assessed by high-sensitivity troponin I impact 1-year mortality in patients undergoing transfemoral TAVI?

P
Population
898 patients with severe aortic stenosis treated with transfemoral TAVI between 2021 and 2023, median age 81.8 years, 58.4% male.
I
Intervention
Assessment of periprocedural myocardial injury using high-sensitivity cardiac troponin I (hs-cTnI) measured preoperatively and between 2nd and 5th postprocedural day.
O
Outcome
Incidence of different myocardial injury definitions and 1-year all-cause mortality.hard clinical

Main Result

Effect estimate: HR 1.93 (95% CI 1.04-3.59)

p-value: p=0.036

Mild to major myocardial injury is common after TAVI when assessed by hs-cTnI, but severe elevations are rare and not consistently associated with increased 1-year all-cause mortality.

Cite This Study

Waldschmidt et al. (2025) conducted a cohort in Severe aortic stenosis (n=898). Transcatheter aortic valve implantation (TAVI) was evaluated on 1-year mortality (HR 1.93, 95% CI 1.04-3.59, p=0.036). Periprocedural myocardial injury assessed by hs-cTnI is common after TAVI but not consistently associated with increased 1-year mortality, despite a higher risk in the 3rd quartile (HR 1.93; p=0.036).

synapsesocial.com/papers/698586118f7c464f23009e47https://doi.org/10.1093/eurheartj/ehaf784.2387
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