Postprocedural myocardial injury and outcomes following transcatheter aortic valve implantation

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has transformed aortic stenosis treatment, yet some patients still experience complications such as post-procedural myocardial injury (PPMI). However, the prognostic significance of PPMI remains unclear. Therefore, this study aimed to investigated the association between post-TAVI cardiac troponin T (cTnT) levels and all-cause mortality.

METHODS: Using Danish nationwide registries (2014-2023), we identified TAVI patients with recorded cTnT measurements before discharge. PPMI was defined as cTnT ≥ 15 times the upper limit of normal (14 ng/L). One-year mortality was analyzed using multivariable Cox regression and results were further elaborated after stratification on sex, age groups, recent PCI (within 3 months), and eGFR groups.

RESULTS: Among 5,187 patients, 866 (16.7 %) had PPMI. Compared to those without PPMI, these patients had longer hospital stays (median 6 vs. 4 days), higher rates of pacemaker implantation (14.2 % vs. 11.4 %), and lower baseline eGFR (54 vs. 63 ml/min). At one year, the cumulative incidence of all-cause mortality was 9.0 % in patients with PPMI versus 6.6 % in those without (p < 0.01. In adjusted analysis, PPMI was associated with an increased risk of one-year mortality (HR 1.36; 95 % CI 1.04-1.77). No effect modification was found irrespective of sex, age groups, or eGFR. However, PPMI patients with recent PCI did not carry an increased rate of mortality (HR 0.88; 95 % CI 0.28-2.75).

CONCLUSION: PPMI following TAVI was linked to higher one-year mortality and myocardial infarction rates, highlighting the need for increased clinical awareness in this patient subgroup.