Michael Michail1,2, James N Cameron3, Nitesh Nerlekar1, Abdul Rahman Ihdayhid1, Liam M McCormick1, Robert Gooley1, Giampaolo Niccoli4, Filippo Crea4, Rocco A Montone4, Adam J Brown1. 1. Monash Cardiovascular Research Centre and MonashHeart, Monash Health, Melbourne, Australia (M.M., N.N., A.R.I., L.M.M., R.G., A.J.B.). 2. Institute of Cardiovascular Science, University College London, United Kingdom (M.M.). 3. St George's University of London, United Kingdom (J.N.C.). 4. Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (G.N., F.C., R.A.M.).
Abstract
BACKGROUND: The aim was to assess whether periprocedural myocardial injury (PPMI) predicts outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). PPMI is a strong predictor of outcomes following coronary intervention, but its impact in the context of TAVR remains unclear. We performed a systematic review and meta-analysis to ascertain the association between PPMI and short- or long-term outcomes. METHODS AND RESULTS: Electronic searches identified studies reporting PPMI following TAVR. Primary end point was 30-day all-cause mortality, with secondary end points, including 1-year all-cause mortality, neurological events, post-TAVR pacemaker implantation, and aortic regurgitation. Analyses were performed using random effects modeling and reported as summary odds ratio (OR) with 95% CI. Nine studies comprising 3442 patients (mean age 81.0±6.6 years, 51.2% female) were included. PPMI occurred in 25.5% of patients following TAVR. The pooled all-cause mortality at 30-days and 1-year was 5.2% and 18.6%, respectively. The occurrence of PPMI following TAVR was associated with significantly increased risk of both 30-day (OR, 4.23; CI, 1.95-9.19; P<0.001) and 1-year all-cause mortality (OR, 1.77; CI, 1.05-2.99; P<0.001). Similarly, PPMI was associated with post-TAVR neurological events (OR, 2.72; CI, 1.69-4.37; P<0.001) and post-TAVR permanent pacing (OR, 1.43; CI, 1.02-2.00; P=0.04) but not with a statistically significant increase in aortic regurgitation post-TAVR (OR, 1.39; CI, 0.93-2.08; P=0.11). CONCLUSIONS: PPMI is common following TAVR and is strongly associated with 30-day and 1-year mortality. Detection of PPMI has potential to identify TAVR patients at highest risk of subsequent adverse events.
BACKGROUND: The aim was to assess whether periprocedural myocardial injury (PPMI) predicts outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). PPMI is a strong predictor of outcomes following coronary intervention, but its impact in the context of TAVR remains unclear. We performed a systematic review and meta-analysis to ascertain the association between PPMI and short- or long-term outcomes. METHODS AND RESULTS: Electronic searches identified studies reporting PPMI following TAVR. Primary end point was 30-day all-cause mortality, with secondary end points, including 1-year all-cause mortality, neurological events, post-TAVR pacemaker implantation, and aortic regurgitation. Analyses were performed using random effects modeling and reported as summary odds ratio (OR) with 95% CI. Nine studies comprising 3442 patients (mean age 81.0±6.6 years, 51.2% female) were included. PPMI occurred in 25.5% of patients following TAVR. The pooled all-cause mortality at 30-days and 1-year was 5.2% and 18.6%, respectively. The occurrence of PPMI following TAVR was associated with significantly increased risk of both 30-day (OR, 4.23; CI, 1.95-9.19; P<0.001) and 1-year all-cause mortality (OR, 1.77; CI, 1.05-2.99; P<0.001). Similarly, PPMI was associated with post-TAVR neurological events (OR, 2.72; CI, 1.69-4.37; P<0.001) and post-TAVR permanent pacing (OR, 1.43; CI, 1.02-2.00; P=0.04) but not with a statistically significant increase in aortic regurgitation post-TAVR (OR, 1.39; CI, 0.93-2.08; P=0.11). CONCLUSIONS: PPMI is common following TAVR and is strongly associated with 30-day and 1-year mortality. Detection of PPMI has potential to identify TAVR patients at highest risk of subsequent adverse events.
Authors: Matthias Schindler; Florin Stöckli; Rico Brütsch; Philipp Jakob; Erik Holy; Jonathan Michel; Robert Manka; Paul Vogt; Christian Templin; Markus Kasel; Frank Ruschitzka; Barbara E Stähli Journal: J Am Heart Assoc Date: 2021-10-29 Impact factor: 5.501