Incidence, Predictors and Outcomes of Myocardial Injury Following Transcatheter Aortic Valve Implantation (TAVI)

Background: Myocardial injury following transcatheter aortic valve implantation (TAVI) is common. However, its impact on medium- and long-term outcomes remains controversial. Methods: We analysed 400 patients undergoing TAVI for severe symptomatic aortic stenosis between 2008 and 2018. Troponin-I values were collected within 24 hours post procedure. Post-procedure myocardial injury (PPMI) was defined as troponin 15x the upper limit of normal based on Valve Academic Research Consortium (VARC)-2 criteria. The primary end-point was 2-year mortality. Results: Mean age of the cohort was 82 ± 7 years; 46% were female. PPMI occurred in 64% (254) of patients. Multivariable logistic regression analysis demonstrated older generation valves Sapien XT (OR 14.2, 95%CI 2.72-74.5, p < 0.01) and CoreValve ‘classic’ (OR 3.51, 95%CI 1.54-8.00, p < 0.01), as well as higher ejection fraction pre-TAVI (OR 1.03, 95%CI 1.01-1.06, p < 0.01) were associated with PPMI. Atrial fibrillation (OR 0.60, 95%CI 0.37-1.00, p = 0.05) and diabetes mellitus (OR 0.38, 95%CI 0.23-0.62) were protective. Patients who had PPMI had longer hospital stay (5 days IQR 4-7 vs. 4 days IQR 3-6, p = 0.02), however PPMI was not associated with complication rates, 30-day or 1-year outcomes. Kaplan-Meier survival analysis up to two years demonstrated lower survival for those who had PPMI (86% vs. 96%, log-rank p = 0.05). On multivariable analysis PPMI was an independent predictor of 2-year mortality (OR 4.26, 95%CI 1.26-14.4, p = 0.02). Conclusion: PPMI occurs in the majority of patients undergoing TAVI and is independently associated with longer hospital stay and lower 2-year survival. Higher LVEF, and older generation valves were independent predictors of PPMI.