Clinical and Functional Outcomes Associated With Myocardial Injury After Transfemoral and Transapical Transcatheter Aortic Valve Replacement A Subanalysis From the PARTNER Trial (Placement of Aortic Transcatheter Valves)

• Type of Material: Article
• Authors: Jean-Michel Paradis, Quebec Heart and Lung Institute; Hersh S. Maniar, Washington University; John M. Lasala, Washington University; Susheel Kodali, Cardiovascular Research Foundation; Mathew Williams, NYU Langone Medical Center; Brian R. Lindman, Washington University; Ralph J. Damiano, Washington University; Marc R. Moon, Washington University; Marc R. Makkar, Cedars Sinai Heart Institute; Vinod Thourani, Emory University; Vasilis Babaliaros, Emory University; Ke Xu, Cardiovascular Research Foundation; Girma Minalu Ayele, Cardiovascular Research Foundation; Lars Svensson, Cleveland Clinic Foundation; Martin B. Leon, Cardiovascular Research Foundation; Alan Zajarias, Washington University
• Language: English
• Date: 2015-09-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American College of Cardiology Foundation.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcin.2015.06.018
• Title of Journal or Parent Work: JACC: Cardiovascular Interventions
• ISSN: 1936-8798
• Volume: 8
• Issue: 11
• Start Page: 1468
• End Page: 1479
• Grant/Funding Information: The PARTNER trial was funded by Edwards Lifesciences and designed collaboratively by the steering committee and the sponsor.; Dr. Brian Lindman was supported by K23 HL116660 from the NIH.
• Keywords: IMPLANTATION; transcatheter aortic valve replacement; creatine kinase-myocardial band; STENOSIS; myocardial injury; Cardiac & Cardiovascular Systems; SURGERY; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; END-POINT DEFINITIONS; troponin; PREDICTORS; Science & Technology; PERCUTANEOUS CORONARY INTERVENTION; PROGNOSTIC VALUE
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

Abstract

Objectives This study sought to clarify the clinical and echocardiographic prognostic implication of myocardial injury after transcatheter aortic valve replacement (TAVR). Background The clinical significance of cardiac biomarker elevation after TAVR remains unclear. Methods Patients treated with TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) trial were divided into tertiles (T1, T2, T3) based on the difference between the values on post-procedure day 1 and the baseline values of 2 cardiac biomarkers: cardiac troponin I (ΔcTnI); and creatine kinase-myocardial band (ΔCK-MB) fraction. Patients were stratified according to their access route: transfemoral (TF) (n = 1,840) or transapical (TA) (n = 1,173). Results At 30 days after TF-TAVR, patients in the highest tertile (T3) of cardiac biomarker elevation had a higher rate of all-cause mortality (ΔcTnI: T3: 5.4% vs. T1: 0.5%, p = 0.006; ΔCK-MB: T3: 5.7% vs. T1: 0.9%, p = 0.006) and cardiovascular mortality (ΔcTnI: T3: 4.9% vs. T1: 0.5%, p = 0.01; ΔCK-MB: T3: 3.9% vs. T1: 0.5%, p = 0.02). At 1 year, only patients in the highest CK-MB tertile had higher rates of all-cause (25.4% vs. 16.8%, p = 0.02) and cardiovascular (10.3% vs. 5.0%) mortality. Multivariable analysis demonstrated that greater release of cardiac biomarkers was independently associated with increased mortality in the TF population. After TA-TAVR, being in the highest tertile of cardiac biomarker elevation had no influence on clinical and echocardiographic outcomes at 30 days and 1 year. Conclusions After TF-TAVR, a greater degree of myocardial injury was associated with higher rates of 30-day all-cause and cardiovascular mortality. At 1 year, being in the highest tertile of ΔCK-MB was correlated with a higher rate of all-cause and cardiac mortality. Finally, the level of myocardial injury after TA-TAVR had no impact on clinical and echocardiographic outcomes.