Key result
Transcatheter aortic valve replacement was associated with a higher incidence of 180-day acute myocardial infarction compared to surgical replacement (1.59% vs. 0.72%; P<0.001).
Why the study?
Coronary artery disease is common in patients undergoing aortic valve replacement, but differences in clinical features and outcomes of post-TAVR versus post-SAVR AMI are not well known.
Does TAVR compared to SAVR affect the incidence, treatment, and outcomes of subsequent acute myocardial infarction?
Cohort (n=2,659)
Yes
Does TAVR compared to SAVR affect the incidence, treatment, and outcomes of subsequent acute myocardial infarction?
Absolute Event Rate: 1.59% vs 0.72%
p-value: p=<0.001
AMI occurs more frequently within 180 days post-TAVR compared to post-SAVR, and while in-hospital mortality is similar, invasive management is utilized less frequently post-TAVR despite its association with lower mortality.
OBJECTIVES: This study aimed to evaluate the incidence, treatment, and outcomes of acute myocardial infarction (AMI) following transcatheter or surgical aortic valve replacement (TAVR or SAVR). BACKGROUND: Coronary artery disease is common in patients who undergo aortic valve replacement. However, little is known about differences in clinical features of post-TAVR or post-SAVR AMI. METHODS: We retrospectively identified post-TAVR or post-SAVR (including isolated and complex SAVR) patients admitted with AMI using the Nationwide Readmissions Database 2012-2017. Incidence, invasive strategy (coronary angiography or revascularization), and in-hospital outcomes were compared between post-TAVR and post-SAVR AMIs. RESULTS: The incidence of 180-day AMI was higher post-TAVR than post-SAVR (1.59% vs. 0.72%; p < 0.001). Post-TAVR AMI patients (n = 1315), compared with post-SAVR AMI patients (n = 1344), were older, had more comorbidities and more frequent non-ST-elevation AMI (NSTEMI: 86.6% vs. 78.0%; p < 0.001). After propensity-score matching, there was no significant difference in in-hospital mortality between post-TAVR and post-SAVR AMIs (14.7% vs. 16.1%; p = 0.531), but the mortality was high in both groups, particularly in ST-elevation AMI (STEMI: 38.8% vs. 29.2%; p = 0.153). Invasive strategy was used less frequently for post-TAVR AMI than post-SAVR AMI (25.6% vs. 38.3%; p < 0.001). Invasive strategy was associated with lower mortality in both post-TAVR (adjusted odds ratio = 0.40; 95% confidence interval = [0.24-0.66]) and post-SAVR groups (0.60 [0.41-0.88]). CONCLUSIONS: AMI, albeit uncommon, was more frequent post-TAVR than post-SAVR. Patients commonly presented with NSTEMI, but the mortality of STEMI was markedly high. Further studies are needed to understand why a substantial percentage of patients do not receive invasive coronary treatment, particularly after TAVR, despite seemingly better outcomes with invasive strategy.
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Isogai et al. (2021) conducted a cohort in Acute myocardial infarction following aortic valve replacement (n=2,659). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Incidence of 180-day acute myocardial infarction (p=<0.001). Transcatheter aortic valve replacement was associated with a higher incidence of 180-day acute myocardial infarction compared to surgical replacement (1.59% vs. 0.72%; P<0.001).
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