Identification of Periprocedural Myocardial Infarction Using a High-Sensitivity Troponin I Assay in Patients Who Underwent Transcatheter Aortic Valve Implantation
| Autor: | Holger Nef, Thomas Walther, Sandra Schillinger, Christian W. Hamm, Ulrich Fischer-Rasokat, Christian Troidl, Alexander Meyer, Won K. Kim, Johannes Blumenstein, Luise Gaede, Mani Arsalan, Jan Sebastian Wolter, Oliver Dörr, Helge Möllmann, Christoph Liebetrau |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Myocardial Infarction 030204 cardiovascular system & hematology Diagnosis Differential Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Postoperative Complications Troponin T Internal medicine Germany Troponin I medicine Humans 030212 general & internal medicine Myocardial infarction Retrospective Studies Aged 80 and over business.industry Incidence Retrospective cohort study Aortic Valve Stenosis medicine.disease Survival Rate Cohort Preoperative Period cardiovascular system Cardiology Myocardial infarction complications Biomarker (medicine) Female Myocardial infarction diagnosis Cardiology and Cardiovascular Medicine Complication business Biomarkers Follow-Up Studies |
| Zdroj: | The American journal of cardiology. 120(7) |
| ISSN: | 1879-1913 |
| Popis: | Periprocedural myocardial infarction (MI), a rare complication after transcatheter aortic valve implantation (TAVI), is associated with worse outcome. According to the Valve Academic Research Consortium (VARC-2), MI is defined by an increase in cardiac troponin (cTn) and creatine kinase MB (CK-MB) levels; however, many patients show periprocedurally elevated cTn without clinical evidence of MI. The aims of this study were to establish reference values of cardiac troponin I measured with a high-sensitivity assay (hs-cTnI) and to assess the periprocedural diagnostic value of this biomarker in patients who underwent TAVI. Hs-cTnI and CK-MB levels were assessed before and up to 3 days after transfemoral (TF) or transapical (TA) TAVI in 515 patients. A high proportion (61.2%) of patients had elevated hs-cTnI at baseline. According to VARC-2 criteria, almost all TA-patients (99.5%) showed an MI based on hs-cTnI compared with 4.2% based on CK-MB. In TF-patients, 81.1% had an MI based on hs-cTnI compared with 9.0% based on CK-MB. Only 10 patients (2%), however, had a type 1 MI. The ninety-ninth percentile for hs-cTnI was 285 ng/L in the TAVI cohort. After applying a TAVI-specific cutoff the frequency of MI was lower and more realistic (TF: 5% vs 81.1%; p 0.001; TA: 22.2% vs 99.5%; p 0.001). In conclusion, the VARC-2 definition leads to an overestimation of periprocedural MI. Our new TAVI-specific reference values yield a more realistic estimation of the myocardial ischemic risk. hs-cTnI, however, does not seem to be the biomarker of choice for MI detection in this setting. |
| Databáze: | OpenAIRE |
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