DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy.
Heart Vessels. 2021 Nov;36(11):1746-1755. doi: 10.1007/s00380-021-01861-8. Epub 2021 May 7.
Peri-procedural myocardial injury (PPMI) is a common complication after transcatheter valve replacement (TAVR), often remaining clinically silent. The role of valve type on PPMI and the association between PPMI and mortality are still unclear. We sought to evaluate predictors and outcome of PPMI after TAVR, and the impact of self-expandable valve (SEV) vs. balloon-expandable valve (BEV) deployment on PPMI. Consecutive patients who underwent successful TAVR in a single-center from January 2014 to December 2019 were included. PPMI was defined according to a modified Valve Academic Research Consortium (VARC)-2 definition as a post-procedure elevation of troponin (with a peak value ≥ 15-times the upper-reference limit) < 72 h after TAVR. We included 596 patients, of whom 258 (43.3%) were men. Mean age was 83.4 ± 5.5 years. We deployed 368 (61.7%) BEV and 228 (38.3%) SEV. PPMI was observed in 471 (79.0%) patients. At multivariable analysis, SEV (OR 2.70, 95% CI 1.64-4.55, p < 0.001), creatinine clearance (OR 0.98, 95% CI 0.97-1.00, p = 0.011), and baseline ejection fraction (OR 1.05, 95% CI 1.02-1.07, p < 0.001) were independent predictors of PPMI; these findings were also confirmed using a propensity-weighted analysis. Thirty-day and 1-year all-cause mortality rates were 2.5% and 8.1%, respectively. No associations between PPMI and 30-day (p = 0.488) or 1-year (p = 0.139) all-cause mortality were found. Independent predictors of 30-day mortality were increasing EUROSCORE II (HR 1.16 per score point, 95% CI 1.08-1.19, p < 0.001) and life-threatening/major bleeding complications (HR 5.87, 95% CI 1.28-26.58, p = 0.019), whereas EUROSCORE II (HR 1.08, 95% CI 1.04-1.13, p = 0.031) and acute kidney injury (HR 2.59, 95% CI 1.20-5.35, p = 0.020) were related to 1-year mortality. PPMI is frequent after TAVR, but it does not affect 30-day or 1-year all-cause mortality. SEV implantation is associated with an increased frequency of PPMI.
经导管主动脉瓣置换术（TAVR）后发生围手术期心肌损伤（PPMI）是一种常见的并发症，通常临床无症状。瓣膜类型对 PPMI 的影响以及 PPMI 与死亡率之间的关系尚不清楚。我们旨在评估 TAVR 后 PPMI 的预测因素和结果，以及自膨式瓣膜（SEV）与球囊扩张式瓣膜（BEV）部署对 PPMI 的影响。
纳入 2014 年 1 月至 2019 年 12 月在单中心成功接受 TAVR 的连续患者。根据改良的瓣膜学术研究联盟（VARC）-2 定义，将 PPMI 定义为 TAVR 后 72 小时内肌钙蛋白升高（峰值值≥15 倍参考上限）。我们纳入了 596 例患者，其中 258 例（43.3%）为男性。平均年龄为 83.4±5.5 岁。我们部署了 368 个 BEV 和 228 个 SEV。471 例（79.0%）患者发生 PPMI。多变量分析显示，SEV（OR 2.70，95%CI 1.64-4.55，p<0.001）、肌酐清除率（OR 0.98，95%CI 0.97-1.00，p=0.011）和基线射血分数（OR 1.05，95%CI 1.02-1.07，p<0.001）是 PPMI 的独立预测因素；这一发现也通过倾向评分加权分析得到了证实。30 天和 1 年全因死亡率分别为 2.5%和 8.1%。未发现 PPMI 与 30 天（p=0.488）或 1 年（p=0.139）全因死亡率之间存在关联。30 天死亡率的独立预测因素是增加的欧洲心脏手术风险评分 II（HR 1.16/评分点，95%CI 1.08-1.19，p<0.001）和危及生命/重大出血并发症（HR 5.87，95%CI 1.28-26.58，p=0.019），而欧洲心脏手术风险评分 II（HR 1.08，95%CI 1.04-1.13，p=0.031）和急性肾损伤（HR 2.59，95%CI 1.20-5.35，p=0.020）与 1 年死亡率相关。
TAVR 后 PPMI 很常见，但不会影响 30 天或 1 年全因死亡率。SEV 植入与 PPMI 发生率增加相关。
