Key result
A postprocedural troponin elevation >18.3-fold above the upper reference limit was associated with increased long-term mortality after transcatheter aortic valve implantation (adjusted HR 1.90; 95% CI 1.40-2.57; P<0.001).
Why the study?
This study sought to investigate the role of postprocedural troponin elevations in mortality prediction after transcatheter aortic valve implantation and to define the threshold for clinically relevant postprocedure myocardial injury.
Does a >18.3-fold increase in postprocedural troponin predict long-term mortality in patients undergoing TAVI?
Cohort (n=1,333)
Does a >18.3-fold increase in postprocedural troponin predict long-term mortality in patients undergoing TAVI?
A >18.3-fold increase in high-sensitivity cardiac troponin T above the upper reference limit after TAVI is a significant predictor of long-term mortality.
Answers are grounded in this paper and cite their sources.
Troponin elevation may flag higher long-term risk after TAVI; leaves open utility for risk stratification pending prospective validation.
Background This study sought to investigate the role of postprocedural troponin elevations in mortality prediction after transcatheter aortic valve implantation and to define the threshold at which clinically relevant postprocedure myocardial injury determines mortality. Methods and Results A total of 1333 consecutive patients with transcatheter aortic valve implantation with available postprocedural high‐sensitivity cardiac troponin T measurements were included in the analysis. The threshold at which postprocedure myocardial injury determines long‐term mortality was identified using restricted cubic spline analysis. A >18.3‐fold increase of troponin above the upper reference limit was identified as threshold for relevant postprocedure myocardial injury. Associations remained significant in a landmark analysis between 30 days and 2 years (hazard ratio [HR], 1.61, [95% CI, 1.13–2.28]; P =0.01), after adjusting for known confounders (adjusted HR, 1.90 [95% CI, 1.40–2.57]; P <0001), and in subgroups of patients with coronary artery disease (adjusted HR, 2.17 [95% CI, 1.44–3.29]; P <0.001), renal dysfunction (adjusted HR, 1.88 [95% CI, 1.35–2.62]; P <0.001), and intermediate/high surgical risk (adjusted HR, 2.70 [95% CI, 1.40–5.22]; P =0.003). Conclusions This study determined a troponin threshold for the identification of patients at increased mortality risk after transcatheter aortic valve implantation. The proposed definition of postprocedure myocardial injury advances risk stratification in patients with transcatheter aortic valve implantation and may assist in postprocedural patient management.
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A 2021 study conducted a cohort in Transcatheter aortic valve implantation (n=1,333). Postprocedural troponin elevation >18.3-fold above the upper reference limit vs. Troponin elevation ≤18.3-fold above the upper reference limit was evaluated on Long-term mortality (between 30 days and 2 years) (adjusted HR 1.90, 95% CI 1.40-2.57, p=<0.001). A postprocedural troponin elevation >18.3-fold above the upper reference limit was associated with increased long-term mortality after transcatheter aortic valve implantation (adjusted HR 1.90; 95% CI 1.40-2.57; P<0.001).
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