SPC365

Post-TAVI Myocardial Injury: defining a diagnosis

Session: Sessão de Posters 53 - Complicações de TAVI
Speaker: Gonçalo Terleira Batista

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Gonçalo Terleira Batista; Ana Luisa Rocha; Tomás Carlos; Ana L Silva; Maria Rodrigues Simões; Tatiana Pereira Dos Santos; Diogo Fernandes; Joana Guimarães; Gonçalo Ferraz Costa; Joana Delgado Silva; Marco Costa; Lino Gonçalves

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Background:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> In the high-sensitivity troponin (hsTN) era, understanding post transcatheter aortic valve implantation (TAVI) elevated hsTN values and their impact on mortality is critical. This study aims to clarify the link between hsTNI levels and post-TAVI survival, with a focus on identifying the optimal clinical significance cutoff.</span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">In a retrospective study at a tertiary center, we analyzed TAVI patients from July 2021 to November 2022. Peak hsTNI values at 72 hours post-TAVI were collected, and cutoff values were explored using area under the curve (AUC) analysis and Youden&rsquo;s index. The association between hsTNI levels and death was assessed via bivariate analysis, followed by binary logistic regression and Cox regression. The multivariate analysis included&nbsp;gender, diabetes, hypertension, dyslipidemia, atrial fibrillation, tobacco use, peripheral artery disease, congestive heart failure (HF), other valvular disease, malignant neoplasm,&nbsp;laboratory parameters at admission [hemoglobin (Hb), c-reactive protein (cRP) and creatinine], as well as previous myocardial infarction, angioplasty, stroke, and cardiac surgery as independent variables.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Patients with</span>&nbsp;</span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">life-threatening procedural-related complications were excluded.</span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">A cohort of 318 patients, median age 82 years and&nbsp;54% male&nbsp;was monitored for an average of 561 days post-TAVI. Characteristics included 37% diabetics, 85% hypertensives, 31% had HF; median Hb of 12.4g/dL and cRP of 0.27mg/dL. Median hsTNI was 345ng/L, with 39 recorded deaths.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">In the bivariate analysis, hsTNI demonstrated a significant association with mortality (p=0.009), confirmed by AUC of 0.64 (95% CI: 0.54-0.73). This association persisted after adjusting for confounders (p=0.024). HsTNI values divided by 100, in both unadjusted and adjusted Cox regressions, indicated an association with survival&nbsp;(unadjusted HR 1.015, 95% CI: 1.005-1.025; adjusted HR 1.018, 95% CI: 1.007-1.028).</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Regarding cutoff values, hsTNI at 10 times the upper reference limit was associated with increased mortality (p=0.07). Patients exceeding this cutoff showed elevated mortality in both unadjusted (HR 3.01, 95% CI: 1.41-6.43) and adjusted Cox regression (HR 2.73, 95% CI: 1.23-6.10).</span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> Establishing optimal cutoffs for post-procedural myocardial injury in the hsTN era is an ongoing challenge. Our study reaffirms the link between elevated hsTNI values post-TAVI and survival while suggesting a potentially suitable cutoff.</span></span></span></p>