Clinical and Functional Outcomes Associated With Myocardial Injury After Transfemoral and Transapical Transcatheter Aortic Valve Replacement: A Subanalysis From the PARTNER Trial (Placement of Aortic Transcatheter Valves)

JACC Cardiovasc Interv. 2015 Sep;8(11):1468-1479. doi: 10.1016/j.jcin.2015.06.018.

Abstract

Objectives: This study sought to clarify the clinical and echocardiographic prognostic implication of myocardial injury after transcatheter aortic valve replacement (TAVR).

Background: The clinical significance of cardiac biomarker elevation after TAVR remains unclear.

Methods: Patients treated with TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) trial were divided into tertiles (T1, T2, T3) based on the difference between the values on post-procedure day 1 and the baseline values of 2 cardiac biomarkers: cardiac troponin I (ΔcTnI); and creatine kinase-myocardial band (ΔCK-MB) fraction. Patients were stratified according to their access route: transfemoral (TF) (n = 1,840) or transapical (TA) (n = 1,173).

Results: At 30 days after TF-TAVR, patients in the highest tertile (T3) of cardiac biomarker elevation had a higher rate of all-cause mortality (ΔcTnI: T3: 5.4% vs. T1: 0.5%, p = 0.006; ΔCK-MB: T3: 5.7% vs. T1: 0.9%, p = 0.006) and cardiovascular mortality (ΔcTnI: T3: 4.9% vs. T1: 0.5%, p = 0.01; ΔCK-MB: T3: 3.9% vs. T1: 0.5%, p = 0.02). At 1 year, only patients in the highest CK-MB tertile had higher rates of all-cause (25.4% vs. 16.8%, p = 0.02) and cardiovascular (10.3% vs. 5.0%) mortality. Multivariable analysis demonstrated that greater release of cardiac biomarkers was independently associated with increased mortality in the TF population. After TA-TAVR, being in the highest tertile of cardiac biomarker elevation had no influence on clinical and echocardiographic outcomes at 30 days and 1 year.

Conclusions: After TF-TAVR, a greater degree of myocardial injury was associated with higher rates of 30-day all-cause and cardiovascular mortality. At 1 year, being in the highest tertile of ΔCK-MB was correlated with a higher rate of all-cause and cardiac mortality. Finally, the level of myocardial injury after TA-TAVR had no impact on clinical and echocardiographic outcomes.

Keywords: creatine kinase-myocardial band; myocardial injury; transcatheter aortic valve replacement; troponin.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / therapy*
  • Aortic Valve* / diagnostic imaging
  • Aortic Valve* / physiopathology
  • Biomarkers / blood
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / instrumentation
  • Cardiac Catheterization / methods
  • Cardiac Catheterization / mortality
  • Catheterization, Peripheral / adverse effects*
  • Catheterization, Peripheral / methods
  • Catheterization, Peripheral / mortality
  • Chi-Square Distribution
  • Creatine Kinase, MB Form / blood
  • Female
  • Femoral Artery*
  • Heart Diseases / blood
  • Heart Diseases / diagnosis
  • Heart Diseases / etiology*
  • Heart Diseases / mortality
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Heart Valve Prosthesis Implantation / instrumentation
  • Heart Valve Prosthesis Implantation / methods
  • Heart Valve Prosthesis Implantation / mortality
  • Hemodynamics
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Multivariate Analysis
  • Myocardium / metabolism
  • Myocardium / pathology*
  • North America
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Troponin T / blood
  • Ultrasonography

Substances

  • Biomarkers
  • Troponin T
  • Creatine Kinase, MB Form