Key result
Greater post-TAVR CK-MB rise is linked to higher 30-day, late, and cardiovascular mortality.
Why the study?
Cardiac biomarker release post-TAVR is common, but its clinical impact across different valve types and procedural approaches remains unknown.
Cohort (n=1,131)
Yes
Answers are grounded in this paper and cite their sources.
Observational study demonstrates predictors and outcomes of myocardial injury in aortic stenosis patients, indicating opportunities to reduce periprocedural cardiac risk.
BACKGROUND Cardiac biomarker release signifying myocardial injury post-transcatheter aortic valve replacement (TAVR) is common, yet its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown. OBJECTIVES This study sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation post TAVR. METHODS This multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical (TA) approaches were selected in 73.1% and 20.3% of patients, respectively. Creatine kinase-myocardial band (CK-MB) measurements were obtained at baseline and at several time points within the initial 72 h post TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up. RESULTS Overall, 66% of the TAVR population demonstrated some degree of myocardial injury as determined by a rise in CK-MB levels (peak value: 1.6-fold [interquartile range (IQR): 0.9 to 2.8-fold]). A TA approach and major procedural complications were independently associated with higher peak of CK-MB levels (p < 0.01 for all), which translated into impaired systolic left ventricular function at 6 to 12 months post TAVR (p < 0.01). A greater rise in CK-MB levels independently associated with an increased 30-day, late (median of 21 [IQR: 8 to 36] months) overall and cardiovascular mortality (p < 0.001 for all). Any increase in CK-MB levels was associated with poorer clinical outcomes, and there was a stepwise rise in late mortality according to the various degrees of CK-MB increase after TAVR (p < 0.001). CONCLUSIONS Some degree of myocardial injury was detected in two-thirds of patients post TAVR, especially in those undergoing TA-TAVR or presenting with major procedural complications. A greater rise in CK-MB levels associated with greater acute and late mortality, imparting a negative impact on left ventricular function.
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Ribeiro et al. (2015) conducted a cohort in Patients undergoing transcatheter aortic valve replacement (TAVR) (n=1,131). Myocardial injury (rise in CK-MB levels) vs. No or lesser rise in CK-MB levels was evaluated on 30-day, late overall and cardiovascular mortality (p=<0.001). A greater rise in CK-MB levels after transcatheter aortic valve replacement was independently associated with increased 30-day, late overall, and cardiovascular mortality (p < 0.001).
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