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Observational Study
. 2021 Nov 15;98(6):E881-E888.
doi: 10.1002/ccd.29781. Epub 2021 Jun 2.

Impact of high-sensitivity cardiac troponin T on survival and rehospitalization after transcatheter aortic valve replacement

Simon Schoechlin  1 , Undine Schulz  1 , Philip Ruile  1 , Manuel Hein  1 , Martin Eichenlaub  1 , Nikolaus Jander  1 , Franz-Josef Neumann  1 , Christian Valina  1
Affiliations
Observational Study

Impact of high-sensitivity cardiac troponin T on survival and rehospitalization after transcatheter aortic valve replacement

Simon Schoechlin et al. Catheter Cardiovasc Interv. .

Abstract

Background: Constant elevations of the serum concentration of cardiac troponin T (TnT) indicate a myocardial injury that may affect the long-term outcome of transcatheter aortic valve replacement (TAVR).

Objectives: We sought to investigate the impact of pre-TAVR TnT on outcomes after TAVR during long-term follow-up.

Methods: In a retrospective, observational study we compared long term outcomes after TAVR between tertiles of preinterventional high-sensitivity TnT. Systematic follow-up was performed annually for 5 years. The primary endpoint was a composite of all-cause death and any rehospitalization.

Results: Between 2010 and 2018, 2,129 patients with severe aortic valve stenosis underwent TAVR at our institution (mean age 82.6 years, 57.2% female, logistic EuroSCORE 20.5 ± 15.8). Boundaries for TnT tertiles were <21 ng/L and >42 ng/L. The median follow-up was 895 days. Three-year incidences for the primary endpoint were 70.9%, 76.6%, and 81.7% in the low, middle, and high tertile (log rank p < .001). Compared with the first tertile, the corresponding adjusted hazard ratios were 1.23 (95%-CI 1.08-1.40, p < .001) and 1.50 (95%-CI 1.32-1.70, p < .001) for the second and third tertile. We found consistent differences between TnT strata for all-cause death (3-year incidences 23.3%, 33.3%, and 47.1%; adjusted p < .001) and rehospitalization (3-year incidences 64.7%, 68.7% and 72.0%; adjusted p < .001), including significant differences in deaths (p < .001). The association between TnT and outcome was independent of coronary artery disease or low aortic valve gradient.

Conclusions: TnT before TAVR is strongly associated with all-cause death and rehospitalization during 3-year follow-up.

Keywords: coronary artery disease; mortality; rehospitalization; transcatheter aortic valve replacement; troponin T.

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References

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