Troponins have long had diagnostic value not only for infarction. Their ability to predict mortality is well established for all cardiac conditions. Moreover, it has been demonstrated in all critically ill patients, including patients with COVID-19, regardless of the triggering condition.
While their significance in COVID cases is backed by the literature, there was not a robust publication addressing this phenomenon in relation with transcatheter aortic valve replacement (TAVR). This research investigated whether troponin elevation after TAVR is related to mortality, and it sought to determine a threshold.
The study included 1333 consecutive patients who underwent TAVR and had troponin values available.
A relevant injury after TAVR was defined as >18.3-fold increase of troponins compared with the baseline value. This association remained significant at 30 days and at 2 years, after adjusting for all confounding variables (hazard ratio [HR]: 1.90; 95% confidence interval [CI]: 1.40 to 2.57; p < 0001).
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Certain subgroups also experienced mortality rates that were twice as high; examples included patients with coronary artery disease (HR: 2.17; p < 0.001), renal failure (HR: 2.17; p < 0.001), and intermediate or high surgical risk (HR: 2.70; p = 0.003).
Conclusion
This study determined that a 20-fold troponin elevation from the baseline value serves as a threshold for predicting mortality after transcatheter aortic valve replacement.
Original Title: Postprocedural Troponin Elevation and Mortality After Transcatheter Aortic Valve Implantation.
Reference: Matthias Schindler et al. J Am Heart Assoc. 2021 Oct 29;e020739. Online ahead of print. doi: 10.1161/JAHA.120.020739.
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