Key result
Post-TAVI myocardial injury is not linked to higher 365-day mortality.
Why the study?
Does myocardial injury after TAVI increase midterm mortality in patients undergoing non-transapical TAVI?
Cohort (n=130)
No
Does myocardial injury after TAVI increase midterm mortality in patients undergoing non-transapical TAVI?
Myocardial injury is common after non-transapical TAVI but does not appear to be associated with an increased risk of midterm mortality.
Myocardial injury post-TAVI showed no midterm mortality link; leaves open questions on thresholds and longer-term outcomes in larger cohorts.
Our aim was to assess the clinical effects of myocardial injury after transcatheter aortic-valve implantation (TAVI). Between October 2013 and July 2016, 157 patients underwent TAVI with Sapien XT, Sapien 3, or CoreValve prostheses at our institute. Of these, 130 patients for whom the transapical approach was not used were included in this study. Myocardial injury was defined as a peak troponin I level of ≥1.5 ng/mL within 48 hours after TAVI. We evaluated the predictors of myocardial injury and compared the clinical outcomes of 82 patients classified as the myocardial injury group and 44 patients classified as the non-myocardial injury group. The patients were aged 85 ± 6 years. Myocardial injury occurred in 82 patients (65.1%). Age (per 1 increase) (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.01-1.22, P = 0.041), female sex (OR: 3.88, 95% CI: 1.23-12.22, P = 0.021), valve type (Sapien XT; OR: 4.22, 95% CI: 1.15-15.47, P = 0.03, Core valve; OR: 18.12, 95% CI: 2.86-114.59, P = 0.002), balloon aortic valvuloplasty as a bridge therapy (OR: 0.10, 95% CI: 0.02-0.42, P = 0.002), and left ventricular end-diastolic volume (LVEDV) (per 1 increase) (OR: 0.97, 95% CI: 0.95-0.99, P = 0.003) were associated with myocardial injury in a multivariate model. The myocardial injury group did not have a higher rate of midterm (365-day) mortality (log-rank test P = 0.57) than the non-myocardial injury group on Kaplan-Meier analysis. Myocardial injury after TAVI was not associated with midterm mortality.
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Nara et al. (2018) conducted a cohort in Transcatheter aortic-valve implantation (TAVI) (n=130). Myocardial injury (peak troponin I ≥1.5 ng/mL within 48 hours) vs. Non-myocardial injury was evaluated on Midterm (365-day) mortality (p=0.57). Myocardial injury after TAVI was not associated with a higher rate of midterm (365-day) mortality compared to patients without myocardial injury (log-rank P=0.57).
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