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Prognostic Impact of Pre-Transcatheter and Post-Transcatheter Aortic Valve Intervention Troponin: A Large Cohort
Mariama Akodad1, Marco Spaziano1, Bernard Chevalier1
11 Interventional Cardiology Department Ramsay Générale de Santé Institut Cardiovasculaire Paris Sud Massy France.
Insights
Elevated preprocedural troponin levels and myocardial injury predict one-year mortality in patients undergoing transcatheter aortic valve intervention, highlighting troponin
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Prognostic value of biomarkers in transcatheter aortic valve intervention (TAVI) is debated.
- Conflicting data exists regarding the prognostic impact of troponin.
- Need for clarity on preprocedural and postprocedural troponin's role in TAVI outcomes.
Purpose of the Study:
- To evaluate the prognostic significance of preprocedural and postprocedural troponin levels.
- To assess the association between troponin levels and 1-year mortality after TAVI.
Main Methods:
- Prospective measurement of high-sensitivity troponin before and after TAVI in 1390 patients.
- Patients categorized into three tertiles based on preprocedural troponin levels.
- Primary endpoint: 1-year all-cause mortality.
Main Results:
- Higher preprocedural troponin levels (tertiles 2 and 3) were associated with increased 1-year mortality.
- Myocardial injury post-TAVI was a significant predictor of 1-year mortality (HR 1.7, P=0.01).
- The association between myocardial injury and mortality appeared stronger in the lowest troponin tertile.
Conclusions:
- Elevated preprocedural troponin levels are linked to higher 1-year mortality post-TAVI.
- Myocardial injury following TAVI is an independent predictor of 1-year mortality.
- Troponin levels serve as valuable prognostic markers in the TAVI population.
Abstract:
Background Biomarkers were advocated as prognostic factors in patients undergoing transcatheter aortic valve intervention, with contradictory results concerning prognostic impact of troponin. Our aim was to assess the prognostic impact of preprocedural and postprocedural troponin in transcatheter aortic valve intervention. Methods and Results Preprocedural and postprocedural high-sensitivity troponin levels were measured in all patients undergoing transcatheter aortic valve intervention. Primary end point was 1-year mortality. This study included 1390 patients, with a mean age of 83.4±6.8 years. Patients were divided into 3 tertiles according to preprocedural troponin values: tertile 1: 0.001 to 0.023 μg/L; tertile 2: 0.024 to 1.80 μg/L; and T3: 1.81 to 12.1 μg/L. One-year mortality was higher in patients in tertile 2 (hazard ratio, 2.1; P=0.001) and T3 (hazard ratio, 1.8; P=0.009) compared with those in tertile 1. Myocardial injury was predictive of 1-year mortality (hazard ratio, 1.7; P=0.01). This effect may be stronger in the tertile 1 subgroup (hazard ratio, 5.1; P=0.03 [ P value for interaction: 0.18]). Conclusions Elevated preprocedural troponin and myocardial injury are associated with 1-year mortality after transcatheter aortic valve intervention.
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