ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement

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. The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI a...

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Published in:Journal of the American College of Cardiology Vol. 77; no. 17; pp. 2187 - 2199
Main Authors: Faroux, Laurent, Lhermusier, Thibault, Vincent, Flavien, Nombela-Franco, Luis, Tchétché, Didier, Barbanti, Marco, Abdel-Wahab, Mohamed, Windecker, Stephan, Auffret, Vincent, Campanha-Borges, Diego Carter, Fischer, Quentin, Muñoz-Garcia, Erika, Trillo-Nouche, Ramiro, Jorgensen, Troels, Serra, Vicens, Toggweiler, Stefan, Tarantini, Giuseppe, Saia, Francesco, Durand, Eric, Donaint, Pierre, Gutierrez-Ibanes, Enrique, Wijeysundera, Harindra C, Veiga, Gabriela, Patti, Giuseppe, D'Ascenzo, Fabrizio, Moreno, Raul, Hengstenberg, Christian, Chamandi, Chekrallah, Asmarats, Lluis, Hernandez-Antolin, Rosana, Gomez-Hospital, Joan Antoni, Cordoba-Soriano, Juan Gabriel, Landes, Uri, Jimenez-Diaz, Victor Alfonso, Cruz-Gonzalez, Ignacio, Nejjari, Mohammed, Roubille, François, Van Belle, Éric, Armijo, German, Siddiqui, Saifullah, Costa, Giuliano, Elsaify, Sameh, Pilgrim, Thomas, le Breton, Hervé, Urena, Marina, Muñoz-Garcia, Antonio Jesus, Sondergaard, Lars, Bach-Oller, Montserrat, Fraccaro, Chiara, Eltchaninoff, Hélène, Metz, Damien, Tamargo, Maria, Fradejas-Sastre, Victor, Rognoni, Andrea, Bruno, Francesco, Goliasch, Georg, Santaló-Corcoy, Marcelo, Jimenez-Mazuecos, Jesus, Webb, John G, Muntané-Carol, Guillem, Paradis, Jean-Michal, Mangieri, Antonio, Ribeiro, Henrique Barbosa, Campelo-Parada, Francisco, Rodés-Cabau, Josep
Format: Journal Article
Language:English
Published: United States Elsevier 04-05-2021
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Summary: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. The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR. 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. 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. 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.
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ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2021.03.014