Petersen Jeppe K, Østergaard Lauge, Strange Jarl Emanuel, Sørensen Louise Marqvard, de Backer Ole, Køber Lars, Fosbøl Emil
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
Int J Cardiol Heart Vasc. 2025 Aug 19;60:101773. doi: 10.1016/j.ijcha.2025.101773. eCollection 2025 Oct.
Transcatheter aortic valve implantation (TAVI) has transformed aortic stenosis treatment, yet some patients still experience complications such as post-procedural myocardial injury (PPMI). However, the prognostic significance of PPMI remains unclear. Therefore, this study aimed to investigated the association between post-TAVI cardiac troponin T (cTnT) levels and all-cause mortality.
Using Danish nationwide registries (2014-2023), we identified TAVI patients with recorded cTnT measurements before discharge. PPMI was defined as cTnT ≥ 15 times the upper limit of normal (14 ng/L). One-year mortality was analyzed using multivariable Cox regression and results were further elaborated after stratification on sex, age groups, recent PCI (within 3 months), and eGFR groups.
Among 5,187 patients, 866 (16.7 %) had PPMI. Compared to those without PPMI, these patients had longer hospital stays (median 6 vs. 4 days), higher rates of pacemaker implantation (14.2 % vs. 11.4 %), and lower baseline eGFR (54 vs. 63 ml/min). At one year, the cumulative incidence of all-cause mortality was 9.0 % in patients with PPMI versus 6.6 % in those without (p < 0.01. In adjusted analysis, PPMI was associated with an increased risk of one-year mortality (HR 1.36; 95 % CI 1.04-1.77). No effect modification was found irrespective of sex, age groups, or eGFR. However, PPMI patients with recent PCI did not carry an increased rate of mortality (HR 0.88; 95 % CI 0.28-2.75).
PPMI following TAVI was linked to higher one-year mortality and myocardial infarction rates, highlighting the need for increased clinical awareness in this patient subgroup.
经导管主动脉瓣植入术（TAVI）改变了主动脉瓣狭窄的治疗方式，但仍有一些患者会出现诸如术后心肌损伤（PPMI）等并发症。然而，PPMI的预后意义仍不明确。因此，本研究旨在调查TAVI术后心肌肌钙蛋白T（cTnT）水平与全因死亡率之间的关联。
利用丹麦全国性注册数据库（2014 - 2023年），我们识别出出院前有cTnT测量记录的TAVI患者。PPMI定义为cTnT≥正常上限的15倍（14 ng/L）。使用多变量Cox回归分析1年死亡率，并在按性别、年龄组、近期PCI（3个月内）和估算肾小球滤过率（eGFR）组分层后进一步阐述结果。
在5187例患者中，866例（16.7%）发生PPMI。与未发生PPMI的患者相比，这些患者住院时间更长（中位数6天对4天），起搏器植入率更高（14.2%对11.4%），基线eGFR更低（54对63 ml/min）。1年时，PPMI患者的全因死亡率累积发生率为9.0%，而未发生PPMI的患者为6.6%（p < 0.01）。在调整分析中，PPMI与1年死亡率风险增加相关（风险比1.36；95%置信区间1.04 - 1.77）。无论性别、年龄组或eGFR如何，均未发现效应修饰。然而，近期接受PCI的PPMI患者死亡率未增加（风险比0.88；95%置信区间0.28 - 2.75）。
TAVI术后的PPMI与1年更高的死亡率和心肌梗死发生率相关，凸显了对此患者亚组提高临床认识的必要性。
