Post-Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation.

Koskinas, Konstantinos; Stortecky, Stefan; Franzone, Anna; O'Sullivan, Crochan J; Praz, Fabien; Zuk, Katarzyna; Räber, Lorenz; Pilgrim, Thomas; Moschovitis, Aris; Fiedler, Martin; Jüni, Peter; Heg, Dik; Wenaweser, Peter Martin; Windecker, Stephan (2016). Post-Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation. Journal of the American Heart Association, 5(2), e002430. American Heart Association 10.1161/JAHA.115.002430

[img]
Preview
Text
Koskinas JAmHeartAssoc 2016.pdf - Published Version
Available under License Creative Commons: Attribution-Noncommercial (CC-BY-NC).

Download (1MB) | Preview

BACKGROUND Biomarkers of myocardial injury increase frequently during transcatheter aortic valve implantation (TAVI). The impact of postprocedural cardiac troponin (cTn) elevation on short-term outcomes remains controversial, and the association with long-term prognosis is unknown. METHODS AND RESULTS We evaluated 577 consecutive patients with severe aortic stenosis treated with TAVI between 2007 and 2012. Myocardial injury, defined according to the Valve Academic Research Consortium (VARC)-2 as post-TAVI cardiac troponin T (cTnT) >15× the upper limit of normal, occurred in 338 patients (58.1%). In multivariate analyses, myocardial injury was associated with higher risk of all-cause mortality at 30 days (adjusted hazard ratio [HR], 8.77; 95% CI, 2.07-37.12; P=0.003) and remained a significant predictor at 2 years (adjusted HR, 1.98; 95% CI, 1.36-2.88; P<0.001). Higher cTnT cutoffs did not add incremental predictive value compared with the VARC-2-defined cutoff. Whereas myocardial injury occurred more frequently in patients with versus without coronary artery disease (CAD), the relative impact of cTnT elevation on 2-year mortality did not differ between patients without CAD (adjusted HR, 2.59; 95% CI, 1.27-5.26; P=0.009) and those with CAD (adjusted HR, 1.71; 95% CI, 1.10-2.65; P=0.018; P for interaction=0.24). Mortality rates at 2 years were lowest in patients without CAD and no myocardial injury (11.6%) and highest in patients with complex CAD (SYNTAX score >22) and myocardial injury (41.1%). CONCLUSIONS VARC-2-defined cTnT elevation emerged as a strong, independent predictor of 30-day mortality and remained a modest, but significant, predictor throughout 2 years post-TAVI. The prognostic value of cTnT elevation was modified by the presence and complexity of underlying CAD with highest mortality risk observed in patients combining SYNTAX score >22 and evidence of myocardial injury.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Koskinas, Konstantinos; Stortecky, Stefan; Franzone, Anna; O'Sullivan, Crochan John; Praz, Fabien; Zuk, Katarzyna; Räber, Lorenz; Pilgrim, Thomas; Moschovitis, Aris; Fiedler, Martin; Jüni, Peter; Heg, Dierik Hans; Wenaweser, Peter Martin and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2047-9980

Publisher:

American Heart Association

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

01 Mar 2016 15:08

Last Modified:

08 Sep 2017 11:39

Publisher DOI:

10.1161/JAHA.115.002430

PubMed ID:

26896474

Uncontrolled Keywords:

aortic stenosis prognosis transcatheter aortic valve implantation troponin

BORIS DOI:

10.7892/boris.79004

URI:

https://boris.unibe.ch/id/eprint/79004

Actions (login required)

Edit item Edit item
Provide Feedback