ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement |
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| Authors: | Laurent Faroux Thibault Lhermusier Flavien Vincent Luis Nombela-Franco Didier Tchétché Marco Barbanti Mohamed Abdel-Wahab Stephan Windecker Vincent Auffret Diego Carter Campanha-Borges Quentin Fischer Erika Muñoz-Garcia Ramiro Trillo-Nouche Troels Jorgensen Vicens Serra Stefan Toggweiler Giuseppe Tarantini Francesco Saia Josep Rodés-Cabau |
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| Affiliation: | 1. Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada;2. Rangueil University Hospital, Toulouse, France;3. CHU Lille, Institut Coeur et Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France;4. Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain;5. Clinique Pasteur, Toulouse, France;6. A.O.U. Policlinico “G. Rodolico–San Marco”, Catania, Italy;7. Heart Center Leipzig, University of Leipzig, Leipzig, Germany;8. Bern University Hospital, Bern, Switzerland;9. Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, Rennes, France;10. Instituto do Coração (InCor), Heart Institute, University of Sao Paulo, Sao Paulo, Brazil;11. Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France;12. Hospital Universitario Virgen de la Victoria, Málaga, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Spain;13. Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain;14. Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;15. Hospital Universitari Vall d’Hebron, Barcelona, Spain;p. Heart Center Lucerne, Lucerne, Switzerland;q. Padova Univesity Hospital, Padova, Italy;r. Institute of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy;s. Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000, Rouen, France;t. Centre Hospitalier Universitaire de Reims, Service de Cardiologie, Reims, France;u. Hospital Gregorio Maranon, Madrid, Spain;v. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;w. Hospital Universitario Marqués de Valdecilla, Santander, Spain;x. Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy;y. Division of Cardiology, Department of Medical Science, Citta’ della Salute e Della Scienza, University of Turin, Turin, Italy;z. Hospital Universitario La Paz, Madrid, Spain;11. Medical University of Vienna, Vienna, Austria;22. Hôpital Européen Georges Pompidou, Paris, France;33. Hospital Santa Creu i Sant Pau, Barcelona, Spain;44. Hospital Universitario Ramón y Cajal, Madrid, Spain;55. Hospital Universitario Bellvitge, Barcelona, Spain;66. Hospital Universitario de Albacete, Albacete, Spain;77. St. Paul’s Hospital, Vancouver, British Columbia, Canada;88. Hospital Universitario Alvaro Cunqueiro, Vigo, Spain;99. University Hospital Salamanca, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain;1010. Centre Cardiologique du Nord, Saint-Denis, France;1111. PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, France;1212. Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy;1313. Hospital Clínic de Barcelona, Barcelona, Spain |
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| Abstract: | BackgroundAmong patients with acute coronary syndrome following transcatheter aortic valve replacement (TAVR), those presenting with ST-segment elevation myocardial infarction (STEMI) are at highest risk.ObjectivesThe goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR.MethodsThis was a multicenter study including 118 patients presenting with STEMI at a median of 255 days (interquartile range: 9 to 680 days) after TAVR. Procedural features of STEMI after TAVR managed with primary percutaneous coronary intervention (PCI) were compared with all-comer STEMI: 439 non-TAVR patients who had primary PCI within the 2 weeks before and after each post-TAVR STEMI case in 5 participating centers from different countries.ResultsMedian door-to-balloon time was higher in TAVR patients (40 min [interquartile range: 25 to 57 min] vs. 30 min [interquartile range: 25 to 35 min]; p = 0.003). Procedural time, fluoroscopy time, dose-area product, and contrast volume were also higher in TAVR patients (p < 0.01 for all). PCI failure occurred more frequently in patients with previous TAVR (16.5% vs. 3.9%; p < 0.001), including 5 patients in whom the culprit lesion was not revascularized owing to coronary ostia cannulation failure. In-hospital and late (median of 7 months [interquartile range: 1 to 21 months]) mortality rates were 25.4% and 42.4%, respectively (20.6% and 38.2% in primary PCI patients), and estimated glomerular filtration rate <60 ml/min (hazard ratio [HR]: 3.02; 95% confidence interval [CI]: 1.42 to 6.43; p = 0.004), Killip class ≥2 (HR: 2.74; 95% CI: 1.37 to 5.49; p = 0.004), and PCI failure (HR: 3.23; 95% CI: 1.42 to 7.31; p = 0.005) determined an increased risk.ConclusionsSTEMI after TAVR was associated with very high in-hospital and mid-term mortality. Longer door-to-balloon times and a higher PCI failure rate were observed in TAVR patients, partially due to coronary access issues specific to the TAVR population, and this was associated with poorer outcomes. |
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| Keywords: | acute coronary syndrome mortality percutaneous coronary intervention ST-segment elevation myocardial infarction transcatheter aortic valve replacement ACS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" acute coronary syndrome CABG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" coronary artery bypass grafting CAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" coronary artery disease MACCE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" major adverse cardiovascular or cerebrovascular event PCI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" percutaneous coronary intervention RCA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" right coronary artery STEMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" ST-segment elevation myocardial infarction TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement |
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