Periprocedural Myocardial Injury and Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve

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Misha Dagan1, Luke P Dawson2, Julia Stehli1

  • 1Department of Cardiology, Alfred Hospital, Victoria, Australia.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|April 17, 2021
PubMed
Abstract

Insights

Peri-procedural myocardial injury (PPMI) is common after transcatheter aortic valve replacement (TAVR) but not linked to mortality. Incidental coronary artery disease (iCAD) treated with percutaneous coronary intervention (PCI) may reduce long-term mortality in TAVR patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Peri-procedural myocardial injury (PPMI) and incidental coronary artery disease (iCAD) are frequent in patients undergoing transcatheter aortic valve replacement (TAVR).
  • Existing research on the impact of PPMI and iCAD on TAVR outcomes lacks definitive consensus.
  • This study investigates the influence of PPMI and iCAD on long-term mortality following TAVR.

Purpose of the Study:

  • To determine the incidence of PPMI and iCAD in patients undergoing TAVR.
  • To evaluate the association between PPMI and iCAD with long-term mortality after TAVR.
  • To explore factors associated with PPMI and the impact of percutaneous coronary intervention (PCI) for iCAD on TAVR outcomes.

Main Methods:

  • Prospective analysis of 400 patients undergoing TAVR for severe aortic stenosis (2008-2018).
  • PPMI defined as troponin 15× ULN; iCAD defined as ≥50% coronary stenosis (excluding prior CABG).
  • Multivariable logistic regression used to identify predictors of PPMI and assess the impact of iCAD and PCI on mortality.

Main Results:

  • PPMI occurred in 65% of patients, associated with higher LVEF and first-generation valves, but not mortality.
  • iCAD was present in 40% of patients (after excluding prior CABG).
  • Percutaneous coronary intervention (PCI) for iCAD was associated with reduced long-term mortality compared to medical management (aOR 0.37; P=0.03).

Conclusions:

  • PPMI is common post-TAVR and linked to specific patient/procedural factors but not long-term mortality.
  • iCAD is prevalent in TAVR patients and PCI intervention may improve long-term survival.
  • These findings highlight the importance of managing iCAD in TAVR candidates.
Keywords:
Aortic valve stenosisCoronary artery diseaseTranscatheter aortic valve replacementTroponin

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