Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey.
Department of Cardiology, Faculty of Medicine, Atilim University, Medicana International Ankara Hospital, Ankara, Turkey.
Tex Heart Inst J. 2022 Jul 1;49(4). doi: 10.14503/THIJ-20-7380.
Myocardial injury (MI) is not unusual after transcatheter aortic valve replacement (TAVR). To determine precipitating factors and prognostic outcomes of MI after TAVR, we retrospectively investigated relationships between MI after TAVR and aortic root dimensions, baseline patient characteristics, echocardiographic findings, and procedural features. Of 474 patients who underwent transfemoral TAVR for severe aortic stenosis in our tertiary center from June 2011 through June 2018, 188 (mean age, 77.7 ± 7.7 yr; 96 women [51%]) met the study inclusion criteria. Patients were divided into postprocedural MI (PMI) (n=74) and no-PMI (n=114) groups, in accordance with high-sensitivity troponin T levels. We found that MI risk was associated with older age (odds ratio [OR]=1.054; 95% CI, 1.013-1.098; P=0.01), transcatheter heart valve type (OR=10.207; 95% CI, 2.861-36.463; P=0.001), distances from the aortic annulus to the right coronary artery ostium (OR=0.853; 95% CI, 0.731-0.995; P=0.04) and the left main coronary artery ostium (OR=0.747; 95% CI, 0.616-0.906; P=0.003), and baseline glomerular filtration rate (OR=0.985; 95% CI, 0.970-1.000; P=0.04). Moreover, the PMI group had a longer time to hospital discharge (P=0.001) and a higher permanent pacemaker implantation rate (P=0.04) than did the no-PMI group. Our findings may enable better estimation of which patients are at higher risk of MI after TAVR and thus improve the planning and course of clinical care.
经导管主动脉瓣置换术（TAVR）后心肌损伤（MI）并不罕见。为了确定 TAVR 后 MI 的诱发因素和预后结果，我们回顾性研究了 TAVR 后 MI 与主动脉根部尺寸、基线患者特征、超声心动图发现和手术特征之间的关系。在我们的三级中心，从 2011 年 6 月至 2018 年 6 月，对 474 例接受经股 TAVR 治疗严重主动脉瓣狭窄的患者进行了回顾性分析，其中 188 例（平均年龄 77.7±7.7 岁；96 例女性[51%]）符合研究纳入标准。根据高敏肌钙蛋白 T 水平，患者分为术后心肌梗死（PMI）（n=74）和非-PMI（n=114）组。我们发现 MI 风险与年龄较大（比值比[OR]=1.054；95%置信区间，1.013-1.098；P=0.01）、经导管心脏瓣膜类型（OR=10.207；95%置信区间，2.861-36.463；P=0.001）、主动脉瓣环至右冠状动脉开口的距离（OR=0.853；95%置信区间，0.731-0.995；P=0.04）和左主干冠状动脉开口（OR=0.747；95%置信区间，0.616-0.906；P=0.003）以及基线肾小球滤过率（OR=0.985；95%置信区间，0.970-1.000；P=0.04）相关。此外，PMI 组的住院时间延长（P=0.001），永久性起搏器植入率较高（P=0.04）。我们的发现可能使我们能够更好地估计哪些患者在 TAVR 后发生 MI 的风险更高，从而改善临床护理的规划和过程。
