Related Experiment Video
Updated: Jun 5, 2025
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
The impact of myocardial injury on outcomes in TAVI patients
Thorald Stolte1,2, Pedro Lopez-Ayala1, Jakob Reichl1
1Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
Background:
Peri-procedural myocardial injury (PPMI) has been commonly reported after transcatheter aortic valve implantation (TAVI) and may have a potential impact on outcomes. The recent update to the Valve Academic Research Consortium (VARC)-3 criteria for PPMI warrants a comparison with the preceding VARC-2 criteria to understand its implications on patient outcomes.
Aims:
To assess the prognostic significance of PPMI as defined by VARC-3 versus VARC-2 in TAVI patients and evaluate the predictive value of high-sensitivity cardiac troponin T (hs-cTnT) for adverse outcomes within 1 year post-TAVI.
Methods:
Consecutive patients undergoing TAVI in a tertiary university hospital between December 2011 and June 2023, with hs-cTnT concentrations pre- and post-procedurally, were enrolled. The primary outcome was all-cause mortality at 1 year. Secondary outcomes were major cardiac adverse events (MACE), defined as a composite end point including all-cause mortality, unplanned reintervention, stroke, myocardial infarction, or major bleeding at 30 days and 1 year.
Results:
Of 653 patients, 535 (82%) had elevated baseline serum hs-cTnT. It was a significant predictor of 1-year mortality and MACE, whereas post-TAVI hs-cTnT concentrations did not predict outcomes (HR: 1.5, p = 0.21 and HR: 0.943, p = 0.54). 367 (56%) of all patients met VARC-2 PPMI criteria, while only 24 (3.7%) met VARC-3 criteria. Patients meeting VARC-3 criteria had significantly more comorbidities and higher 1-year mortality (25% vs. 9%; p = 0.0047). VARC-2 criteria did not predict higher mortality (9% vs. 9%; p = 0.69).
Conclusions:
Baseline hs-cTnT concentrations strongly predicted 1-year mortality and MACE, while post-procedure levels did not. VARC-3 criteria provided better prognostic discrimination than VARC-2.
Insights
Baseline cardiac troponin levels, not post-procedure, predict outcomes after transcatheter aortic valve implantation (TAVI). The updated Valve Academic Research Consortium (VARC)-3 criteria better identify high-risk patients than VARC-2.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Biomarkers
Background:
- Peri-procedural myocardial injury (PPMI) is common after transcatheter aortic valve implantation (TAVI).
- Updated Valve Academic Research Consortium (VARC)-3 criteria for PPMI require comparison with VARC-2 criteria.
- Understanding PPMI's impact on TAVI outcomes is crucial.
Purpose of the Study:
- To compare the prognostic significance of PPMI using VARC-3 versus VARC-2 criteria in TAVI patients.
- To evaluate high-sensitivity cardiac troponin T (hs-cTnT) as a predictor of 1-year adverse outcomes post-TAVI.
Main Methods:
- Analysis of consecutive TAVI patients (December 2011-June 2023) with pre- and post-procedural hs-cTnT.
- Primary outcome: 1-year all-cause mortality.
- Secondary outcomes: 30-day and 1-year Major Adverse Cardiac Events (MACE).
Main Results:
- Baseline hs-cTnT predicted 1-year mortality and MACE; post-TAVI hs-cTnT did not.
- VARC-3 criteria identified 3.7% of patients, while VARC-2 identified 56%.
- Patients meeting VARC-3 criteria had higher comorbidity burden and 1-year mortality (25% vs. 9%).
Conclusions:
- Baseline hs-cTnT is a strong predictor of mortality and MACE post-TAVI.
- Post-procedure hs-cTnT levels lack prognostic value.
- VARC-3 criteria offer superior prognostic discrimination for TAVI patients compared to VARC-2.
