title: 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).
abstract: OBJECTIVE
  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.
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada; Cardiovascular Research Foundation, New York, New York. Electronic address: jm.paradis@criucpq.ulaval.ca.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Paradis
authors.affiliation: Washington University School of Medicine, St Louis, Missouri.
authors.forename: Hersh S
authors.initials: HS
authors.lastname: Maniar
authors.affiliation: Washington University School of Medicine, St Louis, Missouri.
authors.forename: John M
authors.initials: JM
authors.lastname: Lasala
authors.affiliation: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
authors.forename: Susheel
authors.initials: S
authors.lastname: Kodali
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: Mathew
authors.initials: M
authors.lastname: Williams
authors.affiliation: Washington University School of Medicine, St Louis, Missouri.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lindman
authors.affiliation: Washington University School of Medicine, St Louis, Missouri.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Damiano
authors.affiliation: Washington University School of Medicine, St Louis, Missouri.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
authors.affiliation: Cedars Sinai Heart Institute, Los Angeles, California.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Babaliaros
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Girma Minalu
authors.initials: GM
authors.lastname: Ayele
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Lars
authors.initials: L
authors.lastname: Svensson
authors.affiliation: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Washington University School of Medicine, St Louis, Missouri.
authors.forename: Alan
authors.initials: A
authors.lastname: Zajarias
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016009:Chi-Square Distribution; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D005263:Femoral Artery; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D009656:North America; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form
keywords: creatine kinase-myocardial band; myocardial injury; transcatheter aortic valve replacement; troponin