Koifman Edward, Garcia-Garcia Hector M, Alraies M Chadi, Buchanan Kyle, Hideo-Kajita Alex, Steinvil Arie, Rogers Toby, Ben-Dor Itsik, Pichard Augusto D, Torguson Rebecca, Gai Jiaxiang, Satler Lowell F, Waksman Ron
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Am J Cardiol. 2017 Sep 1;120(5):850-856. doi: 10.1016/j.amjcard.2017.05.059. Epub 2017 Jun 15.
The Valve Academic Research Consortium-2 recommends cutoff levels of cardiac troponin of >15 and of creatine kinase MB (CKMB) of >5 of the upper limit of normal (ULN) as markers of periprocedural myocardial infarction. We aimed to evaluate the correlation of these cutoffs with the survival rate in patients who underwent transcatheter aortic valve implantation (TAVI) through the femoral access. Patients who underwent TAVI were classified according to the postprocedural peak marker level of >15 and >5 ULN for troponin and CKMB, respectively. Baseline characteristics were compared, and the impact of these markers on a 1-year survival rate was assessed. Of 474 patients who underwent TAVI, 77% had a peak troponin level of >15 ULN, whereas only 8% had a CKMB level of >5 ULN. Factors associated with troponin and CKMB elevations differed except for the preserved ejection fraction, which was associated with the elevation of both markers. Patients with troponin elevations had higher rates of postprocedure conduction defects (p = 0.001), whereas patients with CKMB had higher rates of bleeding (p <0.001) and stroke (p = 0.03). A troponin elevation of >15 ULN had no impact on the 1-year survival rate (p = 0.52); however, patients with a CKMB level of >5 ULN had increased mortality (p = 0.008), which remained significant in the multivariate analysis (hazard ratio = 2.02, p = 0.035). Troponin level and CKMB had a good correlation (r = 0.7), and a troponin level of 75 ULN was linked with a CKMB level of >5 ULN. In conclusion, cardiac markers differ in their peak levels above the ULN after TAVI. Careful attention should be taken for patients who underwent TAVI with a CKMB level of >5 ULN, as this is the only biomarker independently associated with survival rate.
瓣膜学术研究联盟-2推荐，将心肌肌钙蛋白高于正常上限（ULN）的15倍以及肌酸激酶MB（CKMB）高于正常上限的5倍作为围手术期心肌梗死的标志物。我们旨在评估这些临界值与经股动脉途径进行经导管主动脉瓣植入术（TAVI）患者生存率的相关性。接受TAVI的患者分别根据术后心肌肌钙蛋白高于15倍ULN以及CKMB高于5倍ULN的峰值标志物水平进行分类。比较基线特征，并评估这些标志物对1年生存率的影响。在474例接受TAVI的患者中，77%的患者心肌肌钙蛋白峰值水平高于15倍ULN，而只有8%的患者CKMB水平高于5倍ULN。除了射血分数保留与两种标志物升高均相关外，与心肌肌钙蛋白和CKMB升高相关的因素有所不同。心肌肌钙蛋白升高的患者术后传导缺陷发生率更高（p = 0.001），而CKMB升高的患者出血发生率更高（p <0.001）和中风发生率更高（p = 0.03）。心肌肌钙蛋白升高至高于15倍ULN对1年生存率没有影响（p = 0.52）；然而，CKMB水平高于5倍ULN的患者死亡率增加（p = 0.008），在多变量分析中这一结果仍然显著（风险比= 2.02，p = 0.035）。心肌肌钙蛋白水平与CKMB具有良好的相关性（r = 0.7），心肌肌钙蛋白水平为75倍ULN与CKMB水平高于5倍ULN相关。总之，TAVI术后心脏标志物高于ULN的峰值水平存在差异。对于CKMB水平高于5倍ULN的TAVI患者应予以密切关注，因为这是唯一与生存率独立相关的生物标志物。
