Journal
EUROINTERVENTION
Volume 13, Issue 2, Pages E153-E160Publisher
EUROPA EDITION
DOI: 10.4244/EIJ-D-16-00558
Keywords
aortic stenosis; imaging modalities; myocardial infarction; transcatheter aortic valve implantation (TAVI)
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Funding
- BHF Project Grant [PG/11/126/29321]
- BHF Clinical Fellowship [FS/12/88/29474]
- BHF Senior Research Fellowship [FS/10/62/28409]
- NIHR Leeds Clinical Research Facility
- British Heart Foundation [PG/11/126/29321] Funding Source: researchfish
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Aims: Myocardial injury assessed using cardiac biomarker release is ubiquitous following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), preventing accurate discrimination between focal myocardial infarction (MI) and global injury. Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging was used to compare rates of new MI following SAVR and TAVI. Methods and results: Identical CMR scans were obtained at baseline and six months post procedure in ninety-six patients undergoing SAVR (n=39) and TAVI (n=57). The rate of new MI was greater following SAVR than TAVI (SAVR, n=10 [26%] vs. TAVI, n=3 [5%], p=0.004). Infarct mass was similar between groups (SAVR 1.1 +/- 0.6 vs. TAVI 2.0 +/- 1.4 g, p=0.395). New MI did not impact on change in LV ejection fraction (SAVR:LGE[+]2.2 +/- 4.7 vs. LGE[-]0.9 +/- 8.0%, p=0.437, TAVI:LGE[+]-0.9 +/- 6.0 vs. LGE[-]2.0 +/- 7.8%, p=0.420). Thirty-four patients (60%) in the TAVI group had non-revascularised coronary artery disease (CAD) at the time of TAVI, of whom three (9%) had new MI. Conclusions: MI is an infrequent complication of TAVI but is more common following SAVR. Infarct size is small following both procedures. The low new infarct rate in TAVI, especially in the context of high rates of non-revascularised CAD, strengthens data from previous studies suggesting that coronary revascularisation pre-TAVI may be unnecessary.
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