PROGNOSTIC IMPACT OF PRE AND POST-PROCEDURAL CARDIAC BIOMARKERS FOR TRANSCATHETER AORTIC VALVE IMPLANTATION

Abstract

Both pre- and post-procedural cardiac biomarkers (troponin and NT-pro-BNP) were advocated as independent prognostic factors after transcatheter aortic valve implantation (TAVI), with an increased 1-month and 1-year mortality, but with contradictory results. The aim of this study was to assess the prognostic impact of these biomarkers in a large single-centre prospective TAVI database. All consecutive patients undergoing TAVI at our institution between October 2006 and October 2015 were included prospectively. Pre-procedural troponin and NT-pro-BNP were assessed the day before the procedure and post-procedural measurements were performed the day after the procedure. These measurements were included in a Cox proportional hazards model along with other pre-procedural variables. Key endpoints were mortality at 1 month and 1 year. In total, 1390 patients were included in this study (66.8% transfemoral). Mean age was 83.4±36.8 years and 47.7% were female. Mean logistic EuroScore was 17.3 ± 11.0%. Median pre- and post-procedural troponin levels were 0.33 ng/L (interquartile range: 0.02 - 2.90) and 0.25 ng/L (0.14 - 2.85), respectively (paired Wilcoxon test: p=0.26). Median pre- and post-procedural NT-pro-BNP level were 1878 XXX (interquartile range: 739 - 4141) and 1714 XXX (684 - 4277), respectively (paired Wilcoxon test: p=0.59). Mortality at 1 month and 1 year were 6.3% (n=87) and 13.9 %(n=190), respectively. Pre-procedural troponin was a predictor of 1-year mortality (HR= 1.07 per increase in 1 ng/L; p=0.021) but not of 1-month mortality. After adjustment for the logistic Euroscore, pre-procedural troponin remained an independent predictor of 1-year mortality (HR: 1.05 per increase in 1 ng/L; p=0.05). Post-procedural troponin, change in troponin, pre- and post-procedural NT-pro-BNP were not predictive of mortality (all p=ns). Four independent predictors of elevated pre-procedural troponin levels were identified: elevated pre-procedural BNP levels, male sex, atrial fibrillation and low glomerular filtration rate. Pre-procedural troponin is associated with 1-year mortality after TAVI. This measurement could be performed to further risk-stratify patients before the procedure.