Post-procedural troponin elevation and clinical outcomes following transcatheter aortic valve implantation

Background--biomarkers of myocardial injury increase frequently during transcatheter aortic valve implantation (tavi). the impact of postprocedural cardiac troponin (ctn) elevation on short-term outcomes remains controversial,and the association with long-term prognosis is unknown. methods and results--we evaluated 577 consecutive patients with severe aortic stenosis treated with tavi between 2007 and 2012. myocardial injury,defined according to the valve academic research consortium (varc)-2 as post-tavi cardiac troponin t (ctnt) >15× the upper limit of normal,occurred in 338 patients (58.1%). in multivariate analyses,myocardial injury was associated with higher risk of all-cause mortality at 30 days (adjusted hazard ratio [hr],8.77; 95% ci,2.07-37.12; p=0.003) and remained a significant predictor at 2 years (adjusted hr,1.98; 95% ci,1.36-2.88; p<0.001). higher ctnt cutoffs did not add incremental predictive value compared with the varc-2-defined cutoff. whereas myocardial injury occurred more frequently in patients with versus without coronary artery disease (cad),the relative impact of ctnt elevation on 2-year mortality did not differ between patients without cad (adjusted hr,2.59; 95% ci,1.27-5.26; p=0.009) and those with cad (adjusted hr,1.71; 95% ci,1.10-2.65; p=0.018; p for interaction=0.24). mortality rates at 2 years were lowest in patients without cad and no myocardial injury (11.6%) and highest in patients with complex cad (syntax score >22) and myocardial injury (41.1%). conclusions--varc-2-defined ctnt elevation emerged as a strong,independent predictor of 30-day mortality and remained a modest,but significant,predictor throughout 2 years post-tavi. the prognostic value of ctnt elevation was modified by the presence and complexity of underlying cad with highest mortality risk observed in patients combining syntax score >22 and evidence of myocardial injury. © 2016 the authors.