经导管主动脉瓣植入术后心肌损伤及预后

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-08-19 DOI:10.1016/j.ijcha.2025.101773

Jeppe K. Petersen , Lauge Østergaard , Jarl Emanuel Strange , Louise Marqvard Sørensen , Ole de Backer , Lars Køber , Emil Fosbøl

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引用次数: 0

摘要

经导管主动脉瓣植入术（TAVI）已经改变了主动脉瓣狭窄的治疗方法，但一些患者仍然会出现术后心肌损伤（PPMI）等并发症。然而，PPMI的预后意义尚不清楚。因此，本研究旨在探讨tavi后心肌肌钙蛋白T （cTnT）水平与全因死亡率之间的关系。方法使用丹麦全国登记（2014-2023），我们确定了出院前记录cTnT测量的TAVI患者。PPMI定义为cTnT≥正常上限（14 ng/L）的15倍。采用多变量Cox回归分析1年死亡率，并在对性别、年龄组、最近PCI（3个月内）和eGFR组进行分层后进一步阐述结果。结果5187例患者中有866例（16.7%）发生PPMI。与没有PPMI的患者相比，这些患者住院时间更长（中位6天vs. 4天），起搏器植入率更高（14.2% vs. 11.4%），基线eGFR更低（54 vs. 63 ml/min）。一年后，PPMI患者的累积全因死亡率为9.0%，而非PPMI患者为6.6% （p < 0.01）。在校正分析中，PPMI与一年死亡风险增加相关（HR 1.36; 95% CI 1.04-1.77）。无论性别、年龄组或eGFR如何，均未发现任何效果改变。然而，近期行PCI的PPMI患者的死亡率并没有增加（HR 0.88; 95% CI 0.28-2.75）。结论：TAVI后ppmi与较高的1年死亡率和心肌梗死发生率相关，强调需要提高该患者亚组的临床意识。

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Postprocedural myocardial injury and outcomes following transcatheter aortic valve implantation

Background

Transcatheter aortic valve implantation (TAVI) has transformed aortic stenosis treatment, yet some patients still experience complications such as post-procedural myocardial injury (PPMI). However, the prognostic significance of PPMI remains unclear. Therefore, this study aimed to investigated the association between post-TAVI cardiac troponin T (cTnT) levels and all-cause mortality.

Methods

Using Danish nationwide registries (2014–2023), we identified TAVI patients with recorded cTnT measurements before discharge. PPMI was defined as cTnT ≥ 15 times the upper limit of normal (14 ng/L). One-year mortality was analyzed using multivariable Cox regression and results were further elaborated after stratification on sex, age groups, recent PCI (within 3 months), and eGFR groups.

Results

Among 5,187 patients, 866 (16.7 %) had PPMI. Compared to those without PPMI, these patients had longer hospital stays (median 6 vs. 4 days), higher rates of pacemaker implantation (14.2 % vs. 11.4 %), and lower baseline eGFR (54 vs. 63 ml/min). At one year, the cumulative incidence of all-cause mortality was 9.0 % in patients with PPMI versus 6.6 % in those without (p < 0.01. In adjusted analysis, PPMI was associated with an increased risk of one-year mortality (HR 1.36; 95 % CI 1.04–1.77). No effect modification was found irrespective of sex, age groups, or eGFR. However, PPMI patients with recent PCI did not carry an increased rate of mortality (HR 0.88; 95 % CI 0.28–2.75).

Conclusion

PPMI following TAVI was linked to higher one-year mortality and myocardial infarction rates, highlighting the need for increased clinical awareness in this patient subgroup.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.