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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement

Laurent Faroux1, Thibault Lhermusier2, Flavien Vincent3

  • 1Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.

Journal of the American College of Cardiology
|April 30, 2021
PubMed

Insights

Patients experiencing ST-segment elevation myocardial infarction (STEMI) after transcatheter aortic valve replacement (TAVR) face high mortality risks. This is linked to longer procedure times and higher percutaneous coronary intervention (PCI) failure rates in this population.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Surgery

Background:

  • Patients undergoing transcatheter aortic valve replacement (TAVR) are at risk for acute coronary syndrome.
  • ST-segment elevation myocardial infarction (STEMI) following TAVR represents a particularly high-risk subgroup.

Purpose of the Study:

  • To investigate the clinical characteristics of STEMI post-TAVR.
  • To analyze the management strategies and outcomes for STEMI after TAVR.
  • To compare STEMI outcomes in TAVR patients with a general STEMI population.

Main Methods:

  • Multicenter study of 118 patients with STEMI after TAVR.
  • Comparison of primary percutaneous coronary intervention (PCI) in TAVR patients versus 439 non-TAVR STEMI patients.
  • Analysis of procedural data, including door-to-balloon times and PCI failure rates.

Main Results:

  • STEMI patients post-TAVR had longer door-to-balloon times (40 min vs. 30 min) and higher PCI failure rates (16.5% vs. 3.9%).
  • Coronary ostia cannulation failure was a specific challenge in TAVR patients.
  • In-hospital and late mortality rates were high (25.4% and 42.4% respectively).
  • Factors predicting increased risk included low estimated glomerular filtration rate, Killip class ≥2, and PCI failure.

Conclusions:

  • STEMI after TAVR is associated with significantly high mortality.
  • Challenges in PCI, including coronary access issues, contribute to poorer outcomes.
  • Timely intervention and management of comorbidities are crucial for improving survival.
Abstract

Keywords:
ST-segment elevation myocardial infarctionacute coronary syndromemortalitypercutaneous coronary interventiontranscatheter aortic valve replacement

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