Postprocedural troponin elevation and mortality after transcatheter aortic valve implantation

Abstract

BACKGROUND: This study sought to investigate the role of postprocedural troponin elevations in mortality prediction after tran-scatheter aortic valve implantation and to define the threshold at which clinically relevant postprocedure myocardial injury determines mortality. METHODS AND RESULTS: A total of 1333 consecutive patients with transcatheter aortic valve implantation with available post-procedural high-sensitivity cardiac troponin T measurements were included in the analysis. The threshold at which postpro-cedure myocardial injury determines long-term mortality was identified using restricted cubic spline analysis. A >18.3-fold increase of troponin above the upper reference limit was identified as threshold for relevant postprocedure myocardial injury. Associations remained significant in a landmark analysis between 30 days and 2 years (hazard ratio [HR], 1.61, [95% CI, 1.13– 2.28]; P=0.01), after adjusting for known confounders (adjusted HR, 1.90 [95% CI, 1.40– 2.57]; P<0001), and in subgroups of patients with coronary artery disease (adjusted HR, 2.17 [95% CI, 1.44– 3.29]; P<0.001), renal dysfunction (adjusted HR, 1.88 [95% CI, 1.35– 2.62]; P<0.001), and intermediate/high surgical risk (adjusted HR, 2.70 [95% CI, 1.40– 5.22]; P=0.003). CONCLUSIONS: This study determined a troponin threshold for the identification of patients at increased mortality risk after tran-scatheter aortic valve implantation. The proposed definition of postprocedure myocardial injury advances risk stratification in patients with transcatheter aortic valve implantation and may assist in postprocedural patient management.