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National Trends and Outcomes of Acute Myocardial Infarction After Transcatheter Aortic Valve Replacement

Tanush Gupta1, Joshua Zimmer1, Rony N Lahoud1

  • 1Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, USA.

JACC. Cardiovascular Interventions
|March 26, 2024
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) patients experiencing acute myocardial infarction (AMI) had similar revascularization rates but higher in-hospital mortality for ST-elevation MI (STEMI) compared to non-TAVR patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Services Research

Background:

  • Prior studies suggest reduced invasive management for acute myocardial infarction (AMI) in patients who have undergone transcatheter aortic valve replacement (TAVR).
  • Understanding the impact of prior TAVR on subsequent AMI care and outcomes is crucial for contemporary patient management.

Purpose of the Study:

  • To investigate if a history of TAVR influences the utilization of coronary revascularization and the in-hospital outcomes of patients experiencing AMI.
  • To analyze these effects within a large, contemporary national dataset.

Main Methods:

  • A retrospective analysis of consecutive TAVR patients from 2016-2022 using the U.S. Vizient Clinical Data Base.
  • Comparison of patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) with or without prior TAVR.
  • Propensity score matching was employed to control for baseline patient characteristic differences.

Main Results:

  • Among 206,229 TAVR patients, STEMI occurred at 25/100,000 person-years and NSTEMI at 229/100,000 person-years.
  • Post-matching, coronary revascularization rates for STEMI (65.3% vs 63.9%) and NSTEMI (41.4% vs 41.7%) were similar between prior TAVR and no prior TAVR groups.
  • In-hospital mortality was higher for STEMI in the prior TAVR group (27.1% vs 16.7%) but lower for NSTEMI (5.8% vs 8.2%) compared to the no prior TAVR group.

Conclusions:

  • Acute myocardial infarction events following TAVR are infrequent.
  • Coronary revascularization rates for STEMI and NSTEMI do not differ between TAVR patients and the general population.
  • In-hospital mortality following STEMI is elevated in patients with a history of TAVR.
Abstract

Keywords:
acute myocardial infarctioncoronary artery diseasemortalityrevascularizationtranscatheter aortic valve replacement

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