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Periprocedural Myocardial Injury Predicts Short- and Long-Term Mortality in Patients Undergoing Transcatheter Aortic

Michael Michail1,2, James N Cameron3, Nitesh Nerlekar1

  • 1Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Melbourne, Australia (M.M., N.N., A.R.I., L.M.M., R.G., A.J.B.).

Circulation. Cardiovascular Interventions
|December 21, 2018
PubMed
Abstract

Insights

Periprocedural myocardial injury (PPMI) is common after transcatheter aortic valve replacement (TAVR) and significantly increases the risk of 30-day and 1-year mortality. Identifying PPMI can help pinpoint TAVR patients with the highest risk of adverse outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Periprocedural myocardial injury (PPMI) is a known risk factor for adverse outcomes after coronary interventions.
  • The prognostic significance of PPMI in patients undergoing transcatheter aortic valve replacement (TAVR) is not well-established.
  • Assessing PPMI's impact is crucial for understanding TAVR patient outcomes.

Purpose of the Study:

  • To evaluate whether periprocedural myocardial injury (PPMI) predicts clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).
  • To perform a systematic review and meta-analysis to determine the association between PPMI and short- and long-term adverse events following TAVR.

Main Methods:

  • Systematic review and meta-analysis of published studies reporting PPMI after TAVR.
  • Inclusion of nine studies with 3442 patients.
  • Analysis of primary endpoint (30-day all-cause mortality) and secondary endpoints (1-year mortality, neurological events, pacemaker implantation, aortic regurgitation) using random effects modeling.

Main Results:

  • PPMI occurred in 25.5% of TAVR patients.
  • PPMI was significantly associated with increased 30-day (OR 4.23) and 1-year all-cause mortality (OR 1.77).
  • PPMI also correlated with higher risks of neurological events (OR 2.72) and permanent pacemaker implantation (OR 1.43).

Conclusions:

  • Periprocedural myocardial injury (PPMI) is a frequent complication following TAVR.
  • PPMI is a strong predictor of both short-term (30-day) and long-term (1-year) mortality after TAVR.
  • Detecting PPMI can identify TAVR patients at elevated risk for adverse events, aiding in risk stratification and management.
Keywords:
coronary artery diseasemortalitymyocardial infarctionpercutaneous coronary interventiontranscatheter aortic valve replacement

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