Predictors and impact of myocardial injury after transcatheter aortic valve replacement : a multicenter registry.

Authors: Barbosa Ribeiro, HenriqueNombela-Franco, Luis; Muñoz, Antonio; Lemos, Pedro A.; Amat Santos, Ignacio J.; Serra, Vicenç; Brito, Fabio Sandoli de; Abizaid, Alexandre; Sarmento-Leite, Rogério; Puri, Rishi; Cheema, Asim; Ruel, Marc; Nietlispach, Fabian; Maisano, Francesco; Moris, Cesar; Valle, Raquel del; Urena Alcazar, MarinaAbdul-Jawad Altisent, OmarDel Trigo, MariaCampelo-Parada, Francisco; Jiménez-Quevedo, Pilar; Alonso-Briales, Juan H.; Gutiérrez, Hipólito; García del Blanco, Bruno; Perin, Marco Antonio; Siqueira, Dimytri; Bernardi, Guilherme; Dumont, ÉricCôté, MélaniePibarot, PhilippeRodés-Cabau, Josep
Abstract: BACKGROUND : Cardiac biomarker release signifying myocardial injury post-transcatheter aortic valve replacement (TAVR) is common, yet its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown. OBJECTIVES : This study sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation post TAVR. METHODS : This multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical (TA) approaches were selected in 73.1% and 20.3% of patients, respectively. Creatine kinase-myocardial band (CK-MB) measurements were obtained at baseline and at several time points within the initial 72 h post TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up. RESULTS : Overall, 66% of the TAVR population demonstrated some degree of myocardial injury as determined by a rise in CK-MB levels (peak value: 1.6-fold [interquartile range (IQR): 0.9 to 2.8-fold]). A TA approach and major procedural complications were independently associated with higher peak of CK-MB levels (p < 0.01 for all), which translated into impaired systolic left ventricular function at 6 to 12 months post TAVR (p < 0.01). A greater rise in CK-MB levels independently associated with an increased 30-day, late (median of 21 [IQR: 8 to 36] months) overall and cardiovascular mortality (p < 0.001 for all). Any increase in CK-MB levels was associated with poorer clinical outcomes, and there was a stepwise rise in late mortality according to the various degrees of CK-MB increase after TAVR (p < 0.001). CONCLUSIONS : Some degree of myocardial injury was detected in two-thirds of patients post TAVR, especially in those undergoing TA-TAVR or presenting with major procedural complications. A greater rise in CK-MB levels associated with greater acute and late mortality, imparting a negative impact on left ventricular function.
Document Type: Article de recherche
Issue Date: 10 November 2015
Open Access Date: Restricted access
Document version: VoR
This document was published in: Journal of the American College of Cardiology, Vol. 66 (19), 2077-2088 (2015)
Elsevier Biomedical
Alternative version: 10.1016/j.jacc.2015.08.881
Collection:Articles publiés dans des revues avec comité de lecture

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