Coronary artery disease is common among patients considered for transcatheter aortic valve implantation (TAVI). With the expansion of the indication for TAVI to a population with lower surgical risk, and therefore younger, there has been a gradual increase in the incidence of coronary events. However, there is limited data on treatment strategy and outcomes in patients with acute myocardial infarction (AMI) after TAVI compared with those who have not undergone TAVI.
The purpose of this study was to examine the incidence, timing, clinical characteristics, management, and outcomes of AMI after TAVI in a contemporary cohort (2016-2022). Researchers used data from the Vizient clinical database, which covers over 1000 centers in the US.
The primary endpoint was in-hospital mortality. Secondary endpoints included bleeding complications, vascular complications, and stroke.
Of the 206,229 patients undergoing TAVI between 2016 and 2022, 144 were hospitalized with ST-segment elevation myocardial infarction (STEMI) and 1321 with non-ST-segment elevation myocardial infarction (NSTEMI), during a mean follow-up of 925 days (interquartile range: 428-1530 days).
Read also: Single Antiplatelet Therapy Following Percutaneous Left Atrial Appendage Occlusion.
The incidence of STEMI was 25 events per 100,000 person-years, and the incidence of NSTEMI was 229 events per 100,000 person-years. The mean time from TAVI to STEMI was 429 days (interquartile range: 181-952 days) and to NSTEMI, 480 days (interquartile range: 193-971 days).
In the comparison branch, with patients without previous TAVI, there were 187,110 patients with STEMI and 414,623 patients with NSTEMI, respectively. There was a higher incidence of NSTEMI in patients who had undergone TAVI (90.2% vs. 68.9%; P <0.001), while the incidence of STEMI was lower in that group (9.8% vs. 31.1%; P <0.001).
Overall, patients with coronary artery disease who had undergone TAVI tended to be older and had a higher comorbidity burden. There were no significant differences between the compared STEMI cohorts (patients with and without previous TAVI) regarding the use of angiography (79.2% vs. 69.4%; P=0.06), angioplasty (63.9% vs. 59.0%; P=0.40), or coronary revascularization (percutaneous coronary intervention [PCI] or myocardial revascularization surgery [MRS]; 65.3% vs. 63.9%; P=0.81).
Read also: LpA: 30-Year Cardiovascular Followup in Primary Prevention Cohorts.
In-hospital mortality was higher in the population who had undergone TAVI (27.1% vs. 16.7%; P=0.03), although there were no differences in the incidence of bleeding, vascular complications, or stroke.
Conclusions
According to this prospective multicenter registry, post-TAVI STEMI is uncommon (NSTEMI is more frequent) and occurs approximately one year after TAVI. When comparing matched cohorts, there was no significant difference in coronary revascularization, either with PCI or MRS, for coronary events. However, when evaluating the primary endpoint of in-hospital mortality, the difference was significant.
Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.
Original Title: National Trends and Outcomes of Acute Myocardial Infarction After Transcatheter Aortic Valve Replacement.
Reference: Gupta T, Zimmer J, Lahoud RN, Murphy HR, Harris AH, Kolte D, Hirashima F, Dauerman HL. National Trends and Outcomes of Acute Myocardial Infarction After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2024 Mar 9:S1936-8798(24)00485-0. doi: 10.1016/j.jcin.2024.02.026. Epub ahead of print. PMID: 38530682.
Subscribe to our weekly newsletter
Get the latest scientific articles on interventional cardiology
