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  • Title: Correlates and Significance of Elevation of Cardiac Biomarkers Elevation Following Transcatheter Aortic Valve Implantation.
    Author: Koifman E, Garcia-Garcia HM, Alraies MC, Buchanan K, Hideo-Kajita A, Steinvil A, Rogers T, Ben-Dor I, Pichard AD, Torguson R, Gai J, Satler LF, Waksman R.
    Journal: Am J Cardiol; 2017 Sep 01; 120(5):850-856. PubMed ID: 28688702.
    Abstract:
    The Valve Academic Research Consortium-2 recommends cutoff levels of cardiac troponin of >15 and of creatine kinase MB (CKMB) of >5 of the upper limit of normal (ULN) as markers of periprocedural myocardial infarction. We aimed to evaluate the correlation of these cutoffs with the survival rate in patients who underwent transcatheter aortic valve implantation (TAVI) through the femoral access. Patients who underwent TAVI were classified according to the postprocedural peak marker level of >15 and >5 ULN for troponin and CKMB, respectively. Baseline characteristics were compared, and the impact of these markers on a 1-year survival rate was assessed. Of 474 patients who underwent TAVI, 77% had a peak troponin level of >15 ULN, whereas only 8% had a CKMB level of >5 ULN. Factors associated with troponin and CKMB elevations differed except for the preserved ejection fraction, which was associated with the elevation of both markers. Patients with troponin elevations had higher rates of postprocedure conduction defects (p = 0.001), whereas patients with CKMB had higher rates of bleeding (p <0.001) and stroke (p = 0.03). A troponin elevation of >15 ULN had no impact on the 1-year survival rate (p = 0.52); however, patients with a CKMB level of >5 ULN had increased mortality (p = 0.008), which remained significant in the multivariate analysis (hazard ratio = 2.02, p = 0.035). Troponin level and CKMB had a good correlation (r = 0.7), and a troponin level of 75 ULN was linked with a CKMB level of >5 ULN. In conclusion, cardiac markers differ in their peak levels above the ULN after TAVI. Careful attention should be taken for patients who underwent TAVI with a CKMB level of >5 ULN, as this is the only biomarker independently associated with survival rate.
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