Abstract 14768: Elevated Baseline Serum High Sensitivity Cardiac Troponin Levels and Mortality Post Transcatheter Aortic Valve Replacement: A Meta-Analysis

Abstract

Introduction: High-sensitive cardiac troponins (hs-cTn) have been associated with worse prognosis and increased mortality post transcatheter aortic valve replacement (post-TAVR). However, limited data on the association prompted us to perform a meta-analysis for further understanding. Methods: PubMed, SCOPUS and Google Scholar were searched until May 2023 using relevant keywords. A random effects model was employed to estimate the odds of pooled pre-procedural hs-cTn levels and post-TAVR mortality. Inter-study heterogeneity was assessed using I2 statistics, and leave-one-out sensitivity analysis was performed with a significance level of p<0.05 Results: The final analysis included six studies (n=4672) with a mean age of 82.7±5.6 and 46% female participants. There are 2 retrospective and 3 prospective studies with median follow up of 1 year. The population exhibited a high prevalence of hypertension, hyperlipidemia, and diabetes. All individuals who underwent TAVR had aortic valve area measuring <1cm2. The combined mean logistic EuroSCORE was calculated as 20.91%±12.88. An increase in pre-procedural hs-cTn levels was associated with significantly higher unadjusted (OR 2.29, 95% CI 1.85-2.84, p<0.01, I2=61.34%) and adjusted odds (aOR 2.01, 95%CI 1.62-2.50, p<0.01, I2=52.81 %) of post-TAVR mortality (Fig. 1). Subgroup analysis revealed elevated mortality risk in both retrospective (OR 1.86, 95% CI: 1.33-2.60, p<0.01) and prospective (OR 2.21, 95% CI: 1.62-3.01, p<0.01) studies (Fig. 1). Furthermore, increased mortality risk persisted during both short-term (less than 2 years; OR 1.86, 95% CI: 1.33-2.60, p<0.01) and long-term (more than 2 years; OR 2.21, 95% CI: 1.62-3.01,p<0.01) follow-up (Fig. 1). Leave-one out sensitivity analysis confirmed the robustness of findings. Conclusion: This meta-analysis provides compelling evidence that elevated pre-procedural levels of hs-cTn serve as a significant predictor of post-TAVR 1-year mortality.