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Author Notes:

Corresponding author: Jean-Michel Paradis, Quebec Heart and Lung Institute, 2725 Chemin Sainte-Foy, Quebec, Quebec, CANADA, G1V 4G5, Email: jm.paradis@criucpg.ulaval.ca, Telephone: 418-656-8711, Fax: 418-656-4581

Dr. Susheel Kodali has received consulting fees from Edwards Lifesciences and is a member of the Scientific Advisory Board for Thubrikar Aortic Valve; Dr Martin B. Leon is a nonpaid member of the PARTNER Trial Executive Committee; Dr. Raj Makkar has received grant support from Edwards Lifesciences and St. Jude Medical, is a consultant for Abbott Vascular, Cordis, and Medtronic, and holds equity in Entourage Medical; Dr. Lars Svensson has is an unpaid member of the PARTNER Trial Executive Committee, holds equity in Cardiosolutions and ValvXchange, and has Intellectual Property Rights/Royalties from Posthorax; Dr. Vinod Thourani is a member of the PARTNER Trial Steering Committee and a consultant for Edwards Lifesciences, Sorin Medical, St. Jude Medical, and DirectFlow; Dr Mathew Williams has received consulting fees from Edwards Lifesciences; Dr Alan Zajarias has received consulting fees from Edwards Lifesciences.

The other authors have no disclosures.

Subjects:

Research Funding:

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:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • creatine kinase-myocardial band
  • myocardial injury
  • transcatheter aortic valve replacement
  • troponin
  • PERCUTANEOUS CORONARY INTERVENTION
  • END-POINT DEFINITIONS
  • PROGNOSTIC VALUE
  • IMPLANTATION
  • PREDICTORS
  • STENOSIS
  • SURGERY

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)

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Journal Title:

JACC: Cardiovascular Interventions

Volume:

Volume 8, Number 11

Publisher:

, Pages 1468-1479

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2015 American College of Cardiology Foundation.

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