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The following is a summary of “Impact of myocardial injury on outcomes in TAVI patients,” published in the December 2024 issue of Cardiology by Stolte et al.    

Peri-procedural myocardial injury (PPMI) is commonly observed in patients experiencing transcatheter aortic valve implantation (TAVI) and may affect the outcomes.  

Researchers conducted a retrospective study assessing the prognostic significance of PPMI defined by Valve Academic Research Consortium (VARC) -3 vs. VARC-2 and evaluated the predictive value of high-sensitivity cardiac troponin T (hs-cTnT) for adverse outcomes.  

They included consecutive patients undergoing TAVI (December 2011 and June 2023) with pre- and post-procedural hs-cTnT concentrations. The primary outcome was all-cause mortality at 1 year, while secondary outcomes included major cardiac adverse events (MACE), described as a composite of all-cause mortality, unplanned reintervention, stroke, myocardial infarction, or major bleeding at 30 days and 1 year.  

The results showed that 535 (82%) of 653 patients had elevated baseline hs-cTnT, a significant predictor of 1-year mortality and MACE. Post-procedural hs-cTnT did not predict outcomes (HR: 1.5, P=0.21 for mortality; HR: 0.943, P=0.54 for MACE), 367 (56%) patients met VARC-2 criteria for PPMI, while only 24 (3.7%) met VARC-3 criteria. Patients meeting VARC-3 criteria had more comorbidities and higher 1-year mortality (25% vs. 9%, P=0.0047), while VARC-2 criteria did not predict mortality (9% vs. 9%, P=0.69).  

They concluded that baseline hs-cTnT levels strongly predicted 1-year mortality and MACE, while post-procedural hs-cTnT did not, VARC-3 criteria provided better prognostic discrimination than VARC-2.  

Source: link.springer.com/article/10.1007/s00392-024-02585-1