Predictors and prognostic value of myocardial injury during transcatheter aortic valve implantation.
BACKGROUND
Myocardial injury is a common complication during cardiac surgery and percutaneous coronary intervention and is associated with postprocedural cardiovascular morbidity and mortality. Limited data have been reported about the occurrence of myocardial damage associated with transcatheter aortic valve implantation (TAVI). Therefore, our purpose was to investigate the incidence, predictors, and prognostic value of myocardial injury during TAVI.


RESULTS
We studied 119 patients (aged 81±8 years; 47 male) who had undergone a TAVI with the Medtronic-CoreValve bioprosthesis. Serum creatine kinase-MB (CK-MB) and cardiac troponin T (cTnT) levels were measured before and after the procedure. Myocardial injury was defined as a postprocedural increase of CK-MB and/or cTnT level >5 times the upper reference limit. After TAVI, the incidence of myocardial injury was 17%, which was independently predicted by procedural duration (in minutes) (odds ratio [OR], 1.04; 95% CI, 1.01-1.06), preprocedural β-blocker use (OR, 0.12; 95% CI, 0.03-0.45), peripheral arterial disease (OR, 6.36; 95% CI, 1.56-25.87), and prosthesis depth (in millimeters) (OR, 1.31; 95% CI, 1.08-1.59). The 30-day mortality after TAVI was 13% and was independently predicted by myocardial injury (OR, 8.54; 95% CI, 2.17-33.52), preprocedural hospitalization (OR, 9.36; 95% CI, 2.55-34.38), and left ventricular mass index (in g/m(2)) (OR, 1.02; 95% CI, 1.00-1.03).


CONCLUSIONS
After transcatheter aortic valve implantation, serum levels of both CK-MB and cTnT increase, reflecting the occurrence of periprocedural myocardial injury. A longer procedural duration, the absence of β-blocker use, peripheral arterial disease, and a deeper prosthesis insertion are associated with myocardial injury. Together with preprocedural hospitalization and left ventricular mass, myocardial injury is an independent predictor for 30-day mortality after TAVI.
Department of Cardiology and Cardio-thoracic surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
Ze Yie
ZY
Yong
Esther M A
EM
Wiegerinck
Kirsten
K
Boerlage-van Dijk
Karel T
KT
Koch
Marije M
MM
Vis
Berto J
BJ
Bouma
José P S
JP
Henriques
Riccardo
R
Cocchieri
Jan J
JJ
Piek
Bas A J M
BA
de Mol
Jan
J
Baan
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D009426:Netherlands; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000150:complications; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D015854:Up-Regulation
D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form