What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=898). Intervention: Transcatheter aortic valve implantation (TAVI). Primary outcome: 1-year mortality (HR 1.93, 95% CI 1.04-3.59, p=0.036).

What does this research mean for the field?

Postoperative hs-cTnI elevation predicts higher mortality in patients undergoing transcatheter aortic valve implantation (TAVI), particularly in the 3rd quartile compared to the 1st quartile. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 6, 2026

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

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).

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?

Population

898 patients with severe aortic stenosis treated with transfemoral TAVI between 2021 and 2023, median age 81.8 years, 58.4% male.

Intervention

Assessment of periprocedural myocardial injury using high-sensitivity cardiac troponin I (hs-cTnI) measured preoperatively and between 2nd and 5th postprocedural day.

Outcome

Incidence of different myocardial injury definitions and 1-year all-cause mortality.hard clinical

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.

Main Result

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

p-value: p=0.036

Abstract

Abstract Background There is conflicting data on the importance of periprocedural myocardial injury (MI) during transcatheter aortic valve implantation (TAVI) and its impact on clinical outcome. The Valve Academic Research Consortium 3 (VARC 3) recommends assessing periprocedural MI using standard sensitivity troponin assays due to the higher level of evidence, however, these assays are increasingly unavailable. This study evaluates the incidence and prognostic impact of periprocedural MI using a modern high-sensitivity troponin I assay in TAVI patients. Methods A total of 898 patients with severe aortic stenosis treated with transfemoral TAVI between 2021 and 2023 were analyzed. High-sensitvity cardiac troponin I (hs-cTnI; Siemens Atellica IM) was measured preoperatively and between 2nd and 5th postprocedural day. Incidence of different MI definitions were calculated: Simple MI according to the 4th universal definition of myocardial infarction (upper reference limit, URL); major MI (5-times URL); MI according to SCAI (35-times URL) and MI according to ARC-2 (70-times URL). Uni- and multivariate regression was performed to identify predictors of postprocedural hs-cTnI elevation. Kaplan-Meier curves for different MI definitions and troponin quartiles were generated, as well as Cox proportional hazard models were used to assess the association between postprocedural hs-cTnI quartiles and 1-year mortality. Results Patients’ median age was 81.8 years, and 58.4% were male. Mean effective orifice area was 0.8 cm2 (interquartile range 0.6-0.9 cm2) and mean transvalvular gradient was 33 mmHg (IQR 23.0-45.0 mmHg). Coronary artery disease was present in 63.0%, 56.8% had a preserved left ventricular ejection fraction (LV-EF). Median postoperative hs-cTnI was 285.0 ng/L (IQR 152.9-579.1 ng/L), with a median delta change of 239.0 ng/L (IQR 108.0-498.2 ng/L) compared to preprocedural values. The incidence of MI varied by definition: 867 (96.5%) fulfilled criteria of simple MI, major MI was found in 538 patients (59.9%), SCAI criteria of MI were met by 63 patients (7.0%), and 18 (2.0%) showed MI according to ARC-2, respectively. After uni- and multivariate regression LV-EF below 55% was an independent predictor of postoperative rise of hs-cTnI. Kaplan-Meier estimates showed no significant difference in all-cause mortality between MI definitions. However, in the Cox model, patients in the 3rd quartile of postoperative hs-cTnI had a higher risk of death compared to the 1st quartile (HR 1.93 (CI 1.04, 3.59; p=0.036)), whereas the 4th quartile was not associated with increased mortality. Conclusion Mild to major myocardial injury is common among patients receiving TAVI, especially when assessed by using hs-cTnI assays. However, severe troponin elevations are rare and may be linked to preexisting heart failure with reduced ejection fraction. Our findings suggest that while MI is common, it is not necessarily associated with increased all-cause mortality.

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