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. 2016 Feb 19;5(2):e002430.
doi: 10.1161/JAHA.115.002430.

Post-Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation

Konstantinos C Koskinas  1 , Stefan Stortecky  1 , Anna Franzone  1 , Crochan J O'Sullivan  1 , Fabien Praz  1 , Katazyrna Zuk  1 , Lorenz Räber  1 , Thomas Pilgrim  1 , Aris Moschovitis  1 , Georg M Fiedler  2 , Peter Jüni  3 , Dik Heg  4 , Peter Wenaweser  1 , Stephan Windecker  5
Affiliations

Post-Procedural Troponin Elevation and Clinical Outcomes Following Transcatheter Aortic Valve Implantation

Konstantinos C Koskinas et al. J Am Heart Assoc. .

Abstract

Background: Biomarkers of myocardial injury increase frequently during transcatheter aortic valve implantation (TAVI). The impact of postprocedural cardiac troponin (cTn) elevation on short-term outcomes remains controversial, and the association with long-term prognosis is unknown.

Methods and results: We evaluated 577 consecutive patients with severe aortic stenosis treated with TAVI between 2007 and 2012. Myocardial injury, defined according to the Valve Academic Research Consortium (VARC)-2 as post-TAVI cardiac troponin T (cTnT) >15× the upper limit of normal, occurred in 338 patients (58.1%). In multivariate analyses, myocardial injury was associated with higher risk of all-cause mortality at 30 days (adjusted hazard ratio [HR], 8.77; 95% CI, 2.07-37.12; P=0.003) and remained a significant predictor at 2 years (adjusted HR, 1.98; 95% CI, 1.36-2.88; P<0.001). Higher cTnT cutoffs did not add incremental predictive value compared with the VARC-2-defined cutoff. Whereas myocardial injury occurred more frequently in patients with versus without coronary artery disease (CAD), the relative impact of cTnT elevation on 2-year mortality did not differ between patients without CAD (adjusted HR, 2.59; 95% CI, 1.27-5.26; P=0.009) and those with CAD (adjusted HR, 1.71; 95% CI, 1.10-2.65; P=0.018; P for interaction=0.24). Mortality rates at 2 years were lowest in patients without CAD and no myocardial injury (11.6%) and highest in patients with complex CAD (SYNTAX score >22) and myocardial injury (41.1%).

Conclusions: VARC-2-defined cTnT elevation emerged as a strong, independent predictor of 30-day mortality and remained a modest, but significant, predictor throughout 2 years post-TAVI. The prognostic value of cTnT elevation was modified by the presence and complexity of underlying CAD with highest mortality risk observed in patients combining SYNTAX score >22 and evidence of myocardial injury.

Keywords: aortic stenosis; prognosis; transcatheter aortic valve implantation; troponin.

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Figures

Figure 1
Figure 1
Proportion of patients (n=577) across increments of post‐TAVI peak cTnT levels expressed as multiples of the upper limit of normal (ULN). cTnT indicates cardiac troponin T; TAVI, transcatheter aortic valve implantation.
Figure 2
Figure 2
Cumulative event curves for all‐cause mortality (A) and cardiovascular death within 2‐year follow‐up (B) in patients with or without post‐TAVI cTnT elevation >15× ULN. cTnT indicates cardiac troponin T; HR, hazard ratio; TAVI, transcatheter aortic valve implantation; Trop, troponin; ULN, upper limit of normal.
Figure 3
Figure 3
Landmark analysis of the cumulative incidence of all‐cause mortality between 30 days and 2 years in patients with or without post‐TAVI cTnT elevation >15× ULN. Adj. HR indicates adjusted hazard ratio; cTnT, cardiac troponin T; HR, hazard ratio; TAVI, transcatheter aortic valve implantation; Trop, troponin; ULN, upper limit of normal.
Figure 4
Figure 4
Kaplan–Meier graphs of the cumulative incidence of all‐cause mortality at 2 years in patients stratified according to presence of coronary artery disease (CAD) and according to post‐TAVI cTnT elevation >15× ULN. Adj. HR indicates adjusted hazard ratio; cTnT, cardiac troponin T; HR, hazard ratio; TAVI, transcatheter aortic valve implantation; Trop, troponin; ULN, upper limit of normal.
See this image and copyright information in PMC

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