Incidence, predictors, and prognostic value of periprocedural myocardial injury after TAVI

Abstract

Background: Myocardial Injury (MI) is a common complication during cardiac surgery and associated with increased mortality. A significant periprocedural rise in cardiac biomarkers occurs frequently following TAVI. However, incidence, predictors, and prognostic value of myocardial injury during TAVI have not been elucidated yet. Methods: 247 patients (aged 81.2±6.2 years; logistic EuroSCORE 26.8±16.8) underwent transfemoral TAVI with use of a self-expanding bioprosthesis (Medtronic CoreValve N=210; Symetis Acurate N=7) or a balloon-expandable Transcatheter Heart Valve (THV) (Edwards-SAPIEN N=30). In all patients, serum creatine kinase-MB (CK-MB) and troponin I (TnI) levels were measured before and after the procedure (1h, 4h, 24h, 48h, 72h, and 7 days). Results: After TAVI, there was a significant inverse relationship between the valve size (23 vs. 26 vs. 29 vs. 31mm) and the 4h-increase of the median TnI (1.95 vs. 1.46 vs. 1.24 vs. 1.32 ng/mL; P=0.005) or CK-MB (12.6 vs. 7.5 vs. 7.0 vs. 6.6 ng/mL; P=0.003). Interestingly, the extent and duration of cardiac biomarker increase was significantly higher in patients undergoing TAVI with the use of a self-expanding bioprosthesis compared to patients with a balloon-expandable THV (see Figure). ![Figure][1] 30-day and 1-year mortality were reported with 4.5% and 19.8%, respectively, and were not related to the incidence of both CK-MB and TnI defined MI after TAVI (P=0.80 and P=0.20). Conclusion: The periprocedural rise in cardiac biomarkers showed an inverse association with the valve size and was significantly higher in patients undergoing TAVI with the use of a self-expanding bioprosthesis compared to patients with a balloon-expandable valve. No association was present between periprocedural MI and mortality up to 3 years by either definition. [1]: pending:yes