The impact of myocardial injury on outcomes in TAVI patients.

Background: 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.

Aims: 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.

Methods: 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.

Results: 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).

Conclusions: 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.