1. Predictors and impact of myocardial injury after transcatheter aortic valve replacement: a multicenter registry.
- Author
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Ribeiro HB, Nombela-Franco L, Muñoz-García AJ, Lemos PA, Amat-Santos I, Serra V, de Brito FS Jr, Abizaid A, Sarmento-Leite R, Puri R, Cheema AN, Ruel M, Nietlispach F, Maisano F, Moris C, Del Valle R, Urena M, Abdul Jawad Altisent O, Del Trigo M, Campelo-Parada F, Jimenez Quevedo P, Alonso-Briales JH, Gutiérrez H, García Del Blanco B, Perin MA, Siqueira D, Bernardi G, Dumont É, Côté M, Pibarot P, and Rodés-Cabau J
- Subjects
- Aged, 80 and over, Echocardiography, Europe epidemiology, Female, Follow-Up Studies, Humans, Incidence, Male, Myocardial Reperfusion Injury diagnosis, Myocardial Reperfusion Injury epidemiology, North America epidemiology, Retrospective Studies, South America epidemiology, Time Factors, Aortic Valve Stenosis surgery, Myocardial Reperfusion Injury etiology, Registries, Risk Assessment, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Background: Cardiac biomarker release signifying myocardial injury post-transcatheter aortic valve replacement (TAVR) is common, yet its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown., Objectives: This study sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation post TAVR., Methods: This multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical (TA) approaches were selected in 73.1% and 20.3% of patients, respectively. Creatine kinase-myocardial band (CK-MB) measurements were obtained at baseline and at several time points within the initial 72 h post TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up., Results: Overall, 66% of the TAVR population demonstrated some degree of myocardial injury as determined by a rise in CK-MB levels (peak value: 1.6-fold [interquartile range (IQR): 0.9 to 2.8-fold]). A TA approach and major procedural complications were independently associated with higher peak of CK-MB levels (p < 0.01 for all), which translated into impaired systolic left ventricular function at 6 to 12 months post TAVR (p < 0.01). A greater rise in CK-MB levels independently associated with an increased 30-day, late (median of 21 [IQR: 8 to 36] months) overall and cardiovascular mortality (p < 0.001 for all). Any increase in CK-MB levels was associated with poorer clinical outcomes, and there was a stepwise rise in late mortality according to the various degrees of CK-MB increase after TAVR (p < 0.001)., Conclusions: Some degree of myocardial injury was detected in two-thirds of patients post TAVR, especially in those undergoing TA-TAVR or presenting with major procedural complications. A greater rise in CK-MB levels associated with greater acute and late mortality, imparting a negative impact on left ventricular function., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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