Schoechlin Simon, Schulz Undine, Ruile Philip, Hein Manuel, Eichenlaub Martin, Jander Nikolaus, Neumann Franz-Josef, Valina Christian
Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany.
Catheter Cardiovasc Interv. 2021 Nov 15;98(6):E881-E888. doi: 10.1002/ccd.29781. Epub 2021 Jun 2.
Constant elevations of the serum concentration of cardiac troponin T (TnT) indicate a myocardial injury that may affect the long-term outcome of transcatheter aortic valve replacement (TAVR).
We sought to investigate the impact of pre-TAVR TnT on outcomes after TAVR during long-term follow-up.
In a retrospective, observational study we compared long term outcomes after TAVR between tertiles of preinterventional high-sensitivity TnT. Systematic follow-up was performed annually for 5 years. The primary endpoint was a composite of all-cause death and any rehospitalization.
Between 2010 and 2018, 2,129 patients with severe aortic valve stenosis underwent TAVR at our institution (mean age 82.6 years, 57.2% female, logistic EuroSCORE 20.5 ± 15.8). Boundaries for TnT tertiles were <21 ng/L and >42 ng/L. The median follow-up was 895 days. Three-year incidences for the primary endpoint were 70.9%, 76.6%, and 81.7% in the low, middle, and high tertile (log rank p < .001). Compared with the first tertile, the corresponding adjusted hazard ratios were 1.23 (95%-CI 1.08-1.40, p < .001) and 1.50 (95%-CI 1.32-1.70, p < .001) for the second and third tertile. We found consistent differences between TnT strata for all-cause death (3-year incidences 23.3%, 33.3%, and 47.1%; adjusted p < .001) and rehospitalization (3-year incidences 64.7%, 68.7% and 72.0%; adjusted p < .001), including significant differences in deaths (p < .001). The association between TnT and outcome was independent of coronary artery disease or low aortic valve gradient.
TnT before TAVR is strongly associated with all-cause death and rehospitalization during 3-year follow-up.
血清心肌肌钙蛋白T（TnT）浓度持续升高表明存在心肌损伤，这可能会影响经导管主动脉瓣置换术（TAVR）的长期预后。
我们试图研究TAVR术前TnT对TAVR术后长期随访结果的影响。
在一项回顾性观察研究中，我们比较了术前高敏TnT三分位数组TAVR术后的长期结果。进行了为期5年的年度系统随访。主要终点是全因死亡和任何再次住院的复合终点。
2010年至2018年期间，我们机构有2129例严重主动脉瓣狭窄患者接受了TAVR（平均年龄82.6岁，女性占57.2%，逻辑EuroSCORE为20.5±15.8）。TnT三分位数的界限分别为<21 ng/L和>42 ng/L。中位随访时间为895天。低、中、高三分位数组主要终点的3年发生率分别为70.9%、76.6%和81.7%（对数秩检验p<0.001）。与第一三分位数组相比，第二和第三三分位数组相应的调整后风险比分别为1.23（95%置信区间1.08-1.40，p<0.001）和1.50（95%置信区间1.32-1.70，p<0.001）。我们发现TnT分层在全因死亡（3年发生率分别为23.3%、33.3%和47.1%；调整后p<0.001）和再次住院（3年发生率分别为64.7%、68.7%和72.0%；调整后p<0.001）方面存在一致差异，包括死亡方面的显著差异（p<0.001）。TnT与预后之间的关联独立于冠状动脉疾病或低主动脉瓣梯度。
TAVR术前TnT与3年随访期间的全因死亡和再次住院密切相关。
