Postprocedural Troponin Elevation and Mortality After Transcatheter Aortic Valve Implantation

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomarkers

Background:

• Transcatheter aortic valve implantation (TAVI) is a key treatment for aortic stenosis.
• Assessing post-TAVI myocardial injury is crucial for patient outcomes.
• Troponin levels are established biomarkers for myocardial injury.

Purpose of the Study:

• To investigate the predictive role of post-TAVI troponin elevations on mortality.
• To define a specific threshold for clinically relevant myocardial injury post-TAVI.
• To improve risk stratification and patient management after TAVI.

Main Methods:

• Analysis of 1333 consecutive TAVI patients with high-sensitivity troponin T measurements.
• Utilized restricted cubic spline analysis to identify mortality-predictive troponin thresholds.
• Conducted landmark analysis and subgroup analyses to validate findings.

Main Results:

• A troponin increase >18.3-fold above the upper reference limit was identified as the threshold for relevant myocardial injury.
• This threshold was significantly associated with long-term mortality (HR 1.61, P=0.01).
• Associations remained significant after multivariable adjustment (aHR 1.90, P<0.001) and in key subgroups.

Conclusions:

• Established a specific troponin threshold for identifying increased mortality risk post-TAVI.
• The proposed definition of post-TAVI myocardial injury enhances risk stratification.
• Findings can guide postprocedural patient management and monitoring.