Periprocedural myocardial injury assessed by hs-cTnI is common after TAVI but not consistently associated with increased 1-year mortality, despite a higher risk in the 3rd quartile (HR 1.93; p=0.036).
Cohort (n=898)
Does periprocedural myocardial injury assessed by high-sensitivity troponin I impact 1-year mortality in patients undergoing transfemoral TAVI?
Mild to major myocardial injury is common after TAVI when assessed by hs-cTnI, but severe elevations are rare and not consistently associated with increased 1-year all-cause mortality.
Effect estimate: HR 1.93 (95% CI 1.04-3.59)
p-value: p=0.036
Abstract Background There is conflicting data on the importance of periprocedural myocardial injury (MI) during transcatheter aortic valve implantation (TAVI) and its impact on clinical outcome. The Valve Academic Research Consortium 3 (VARC 3) recommends assessing periprocedural MI using standard sensitivity troponin assays due to the higher level of evidence, however, these assays are increasingly unavailable. This study evaluates the incidence and prognostic impact of periprocedural MI using a modern high-sensitivity troponin I assay in TAVI patients. Methods A total of 898 patients with severe aortic stenosis treated with transfemoral TAVI between 2021 and 2023 were analyzed. High-sensitvity cardiac troponin I (hs-cTnI; Siemens Atellica IM) was measured preoperatively and between 2nd and 5th postprocedural day. Incidence of different MI definitions were calculated: Simple MI according to the 4th universal definition of myocardial infarction (upper reference limit, URL); major MI (5-times URL); MI according to SCAI (35-times URL) and MI according to ARC-2 (70-times URL). Uni- and multivariate regression was performed to identify predictors of postprocedural hs-cTnI elevation. Kaplan-Meier curves for different MI definitions and troponin quartiles were generated, as well as Cox proportional hazard models were used to assess the association between postprocedural hs-cTnI quartiles and 1-year mortality. Results Patients’ median age was 81.8 years, and 58.4% were male. Mean effective orifice area was 0.8 cm2 (interquartile range 0.6-0.9 cm2) and mean transvalvular gradient was 33 mmHg (IQR 23.0-45.0 mmHg). Coronary artery disease was present in 63.0%, 56.8% had a preserved left ventricular ejection fraction (LV-EF). Median postoperative hs-cTnI was 285.0 ng/L (IQR 152.9-579.1 ng/L), with a median delta change of 239.0 ng/L (IQR 108.0-498.2 ng/L) compared to preprocedural values. The incidence of MI varied by definition: 867 (96.5%) fulfilled criteria of simple MI, major MI was found in 538 patients (59.9%), SCAI criteria of MI were met by 63 patients (7.0%), and 18 (2.0%) showed MI according to ARC-2, respectively. After uni- and multivariate regression LV-EF below 55% was an independent predictor of postoperative rise of hs-cTnI. Kaplan-Meier estimates showed no significant difference in all-cause mortality between MI definitions. However, in the Cox model, patients in the 3rd quartile of postoperative hs-cTnI had a higher risk of death compared to the 1st quartile (HR 1.93 (CI 1.04, 3.59; p=0.036)), whereas the 4th quartile was not associated with increased mortality. Conclusion Mild to major myocardial injury is common among patients receiving TAVI, especially when assessed by using hs-cTnI assays. However, severe troponin elevations are rare and may be linked to preexisting heart failure with reduced ejection fraction. Our findings suggest that while MI is common, it is not necessarily associated with increased all-cause mortality.
Waldschmidt et al. (2025) conducted a cohort in Severe aortic stenosis (n=898). Transcatheter aortic valve implantation (TAVI) was evaluated on 1-year mortality (HR 1.93, 95% CI 1.04-3.59, p=0.036). Periprocedural myocardial injury assessed by hs-cTnI is common after TAVI but not consistently associated with increased 1-year mortality, despite a higher risk in the 3rd quartile (HR 1.93; p=0.036).