Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar;114(3):385-394.
doi: 10.1007/s00392-024-02585-1. Epub 2024 Dec 11.

The impact of myocardial injury on outcomes in TAVI patients

Thorald Stolte  1   2 , Pedro Lopez-Ayala  1 , Jakob Reichl  1 , Anna Pfenniger  1 , Giampiero Allegra  1 , Gregor Leibundgut  1 , Christoph Kaiser  1 , Jasper Boeddinghaus  1 , Felix Mahfoud  1 , Christian Mueller  1 , Thomas Nestelberger  3   4
Affiliations

The impact of myocardial injury on outcomes in TAVI patients

Thorald Stolte et al. Clin Res Cardiol. 2025 Mar.

Abstract

Background: Peri-procedural myocardial injury (PPMI) has been commonly reported after transcatheter aortic valve implantation (TAVI) and may have a potential impact on outcomes. The recent update to the Valve Academic Research Consortium (VARC)-3 criteria for PPMI warrants a comparison with the preceding VARC-2 criteria to understand its implications on patient outcomes.

Aims: To assess the prognostic significance of PPMI as defined by VARC-3 versus VARC-2 in TAVI patients and evaluate the predictive value of high-sensitivity cardiac troponin T (hs-cTnT) for adverse outcomes within 1 year post-TAVI.

Methods: Consecutive patients undergoing TAVI in a tertiary university hospital between December 2011 and June 2023, with hs-cTnT concentrations pre- and post-procedurally, were enrolled. The primary outcome was all-cause mortality at 1 year. Secondary outcomes were major cardiac adverse events (MACE), defined as a composite end point including all-cause mortality, unplanned reintervention, stroke, myocardial infarction, or major bleeding at 30 days and 1 year.

Results: Of 653 patients, 535 (82%) had elevated baseline serum hs-cTnT. It was a significant predictor of 1-year mortality and MACE, whereas post-TAVI hs-cTnT concentrations did not predict outcomes (HR: 1.5, p = 0.21 and HR: 0.943, p = 0.54). 367 (56%) of all patients met VARC-2 PPMI criteria, while only 24 (3.7%) met VARC-3 criteria. Patients meeting VARC-3 criteria had significantly more comorbidities and higher 1-year mortality (25% vs. 9%; p = 0.0047). VARC-2 criteria did not predict higher mortality (9% vs. 9%; p = 0.69).

Conclusions: Baseline hs-cTnT concentrations strongly predicted 1-year mortality and MACE, while post-procedure levels did not. VARC-3 criteria provided better prognostic discrimination than VARC-2.

Keywords: High-sensitivity cardiac troponin T; Peri-procedural myocardial injury; Transcatheter aortic valve implantation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: Thomas Nestelberger has received research support from the Swiss National Science Foundation (P400PM_191037/1), the Prof. Dr. Max Cloëtta Foundation, the Margarete und Walter Lichtenstein-Stiftung (3MS1038), and the University Hospital Basel as well as speaker honoraria/consulting honoraria from Edwards Lifesciences, Siemens, Beckman Coulter, Bayer, Ortho Clinical Diagnostics and Orion Pharma, outside the submitted work. Pedro Lopez-Ayala has received research grants from the Swiss Heart Foundation (FF20079 and FF21103) and speaker’s honoraria from Quidel, paid to the institution and outside the submitted work. Felix Mahfoud is supported by Deutsche Gesellschaft für Kardiologie (DGK), Deutsche Forschungsgemeinschaft (SFB TRR219, Project-ID 322900939), and Deutsche Herzstiftung. Saarland University has received scientific support from Ablative Solutions, Medtronic and ReCor Medical. Until May 2024, FM has received speaker honoraria/consulting fees from Ablative Solutions, Amgen, Astra-Zeneca, Bayer, Boehringer Ingelheim, Inari, Medtronic, Merck, ReCor Medical, Servier, and Terumo. Christian Mueller has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the University Basel, the University Hospital Basel, Abbott, Astra Zeneca, Beckman Coulter, Boehringer Ingelheim, BRAHMS, Critical Diagnostics, Idorsia, Novartis, Ortho Clinical Diagnostics, Quidel, Roche, Siemens, Singulex, Sphingotec, and SpinChip, as well as speaker/consulting honoraria from Astra Zeneca, Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Idorsia, Osler, Novartis, Roche, Sanofi, Siemens, Singulex, and SpinChip, all paid to the institution. All other authors declare that they have no conflict of interest with this study and that they have critically reviewed the manuscript and approved the final version for submission. The manuscript and its contents have not been published previously and are not being considered for publications elsewhere in whole or in part in any language, including publicly accessible web sites or e-print servers.

Figures

Fig. 1
Fig. 1
Patient flowchart
Fig. 2
Fig. 2
a Elevation of troponin from before to after interventions. The red dashed line represents the upper reference limit cutoff of 14 ng/L. b Comparison of high-sensitivity troponin T elevations for VARC-2 & 3 defined peri-procedural myocardial injury (PPMI)
Fig. 3
Fig. 3
a Comparison of Kaplan–Meier 1-year mortality between VARC-2- and VARC-3 defined PPMI versus non-PPMI. b Comparison of Kaplan–Meier 1-year MACE-incidence between VARC-2- and VARC-3-defined PPMI versus non-PPMI
Fig. 4
Fig. 4
Partial (conditional) effects plots of baseline hs-cTnT for A death and B major adverse cardiac events (MACE). Y-axis represents the probability of event-free survival for MACE/death at 1 year
See this image and copyright information in PMC

References

    1. Mack MJ, Leon MB, Thourani VH, Pibarot P, Hahn RT, Genereux P et al (2023) Transcatheter aortic-valve replacement in low-risk patients at five years. N Engl J Med 389(21):1949–1960 - DOI - PubMed
    1. Forrest JK, Deeb GM, Yakubov SJ, Gada H, Mumtaz MA, Ramlawi B et al (2023) 4-Year outcomes of patients with aortic stenosis in the evolut low risk trial. J Am Coll Cardiol 82(22):2163–2165 - DOI - PubMed
    1. Jørgensen TH, Thyregod HGH, Ihlemann N, Nissen H, Petursson P, Kjeldsen BJ et al (2021) Eight-year outcomes for patients with aortic valve stenosis at low surgical risk randomized to transcatheter vs. surgical aortic valve replacement. Eur Heart J 42(30):2912–2919 - DOI - PMC - PubMed
    1. Steffen J, Reißig N, Andreae D, Beckmann M, Haum M, Fischer J et al (2022) TAVI in patients with low-flow low-gradient aortic stenosis-short-term and long-term outcomes. Clin Res Cardiol 111(12):1325–1335 - DOI - PMC - PubMed
    1. Parikh PB, Mack M, Stone GW, Anker SD, Gilchrist IC, Kalogeropoulos AP et al (2024) Transcatheter aortic valve replacement in heart failure. Eur J Heart Fail 26(2):460–470 - DOI - PubMed