Stolte Thorald, Lopez-Ayala Pedro, Reichl Jakob, Pfenniger Anna, Allegra Giampiero, Leibundgut Gregor, Kaiser Christoph, Boeddinghaus Jasper, Mahfoud Felix, Mueller Christian, Nestelberger Thomas
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland.
Clin Res Cardiol. 2025 Mar;114(3):385-394. doi: 10.1007/s00392-024-02585-1. Epub 2024 Dec 11.
Peri-procedural myocardial injury (PPMI) has been commonly reported after transcatheter aortic valve implantation (TAVI) and may have a potential impact on outcomes. The recent update to the Valve Academic Research Consortium (VARC)-3 criteria for PPMI warrants a comparison with the preceding VARC-2 criteria to understand its implications on patient outcomes.
To assess the prognostic significance of PPMI as defined by VARC-3 versus VARC-2 in TAVI patients and evaluate the predictive value of high-sensitivity cardiac troponin T (hs-cTnT) for adverse outcomes within 1 year post-TAVI.
Consecutive patients undergoing TAVI in a tertiary university hospital between December 2011 and June 2023, with hs-cTnT concentrations pre- and post-procedurally, were enrolled. The primary outcome was all-cause mortality at 1 year. Secondary outcomes were major cardiac adverse events (MACE), defined as a composite end point including all-cause mortality, unplanned reintervention, stroke, myocardial infarction, or major bleeding at 30 days and 1 year.
Of 653 patients, 535 (82%) had elevated baseline serum hs-cTnT. It was a significant predictor of 1-year mortality and MACE, whereas post-TAVI hs-cTnT concentrations did not predict outcomes (HR: 1.5, p = 0.21 and HR: 0.943, p = 0.54). 367 (56%) of all patients met VARC-2 PPMI criteria, while only 24 (3.7%) met VARC-3 criteria. Patients meeting VARC-3 criteria had significantly more comorbidities and higher 1-year mortality (25% vs. 9%; p = 0.0047). VARC-2 criteria did not predict higher mortality (9% vs. 9%; p = 0.69).
Baseline hs-cTnT concentrations strongly predicted 1-year mortality and MACE, while post-procedure levels did not. VARC-3 criteria provided better prognostic discrimination than VARC-2.
经导管主动脉瓣植入术（TAVI）后围手术期心肌损伤（PPMI）较为常见，可能对预后产生潜在影响。瓣膜学术研究联盟（VARC）-3关于PPMI的标准最近更新，有必要与之前的VARC-2标准进行比较，以了解其对患者预后的影响。
评估VARC-3与VARC-2定义的PPMI在TAVI患者中的预后意义，并评估高敏心肌肌钙蛋白T（hs-cTnT）对TAVI术后1年内不良结局的预测价值。
纳入2011年12月至2023年6月在一家三级大学医院接受TAVI的连续患者，记录其术前和术后的hs-cTnT浓度。主要结局是1年时的全因死亡率。次要结局是主要心脏不良事件（MACE），定义为包括30天和1年时全因死亡率、计划外再次干预、中风、心肌梗死或大出血的复合终点。
653例患者中，535例（82%）基线血清hs-cTnT升高。它是1年死亡率和MACE的显著预测因子，而TAVI术后hs-cTnT浓度不能预测结局（HR：1.5，p = 0.21；HR：0.943，p = 0.54）。所有患者中367例（56%）符合VARC-2 PPMI标准，而只有24例（3.7%）符合VARC-3标准。符合VARC-3标准的患者合并症显著更多，1年死亡率更高（25%对9%；p = 0.0047）。VARC-2标准不能预测更高的死亡率（9%对9%；p = 0.69）。
基线hs-cTnT浓度强烈预测1年死亡率和MACE，而术后水平则不然。VARC-3标准比VARC-2提供了更好的预后区分。
