JOURNAL ARTICLE

ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement

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, Eric Durand, Pierre Donaint, Enrique Gutierrez-Ibanes, Harindra C Wijeysundera, Gabriela Veiga, Giuseppe Patti, Fabrizio D'Ascenzo, Raul Moreno, Christian Hengstenberg, Chekrallah Chamandi, Lluis Asmarats, Rosana Hernandez-Antolin, Joan Antoni Gomez-Hospital, Juan Gabriel Cordoba-Soriano, Uri Landes, Victor Alfonso Jimenez-Diaz, Ignacio Cruz-Gonzalez, Mohammed Nejjari, François Roubille, Éric Van Belle, German Armijo, Saifullah Siddiqui, Giuliano Costa, Sameh Elsaify, Thomas Pilgrim, Hervé le Breton, Marina Urena, Antonio Jesus Muñoz-Garcia, Lars Sondergaard, Montserrat Bach-Oller, Chiara Fraccaro, Hélène Eltchaninoff, Damien Metz, Maria Tamargo, Victor Fradejas-Sastre, Andrea Rognoni, Francesco Bruno, Georg Goliasch, Marcelo Santaló-Corcoy, Jesus Jimenez-Mazuecos, John G Webb, Guillem Muntané-Carol, Jean-Michal Paradis, Antonio Mangieri, Henrique Barbosa Ribeiro, Francisco Campelo-Parada, Josep Rodés-Cabau
Journal of the American College of Cardiology 2021 May 4, 77 (17): 2187-2199
33926655

BACKGROUND: Among patients with acute coronary syndrome following transcatheter aortic valve replacement (TAVR), those presenting with ST-segment elevation myocardial infarction (STEMI) are at highest risk.

OBJECTIVES: The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR.

METHODS: This 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.

RESULTS: Median 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.

CONCLUSIONS: STEMI 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.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read
33926655
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"