National Trends and Outcomes of Acute Myocardial Infarction After Transcatheter Aortic Valve Replacement

Tanush Gupta; Joshua Zimmer; Rony N Lahoud; Hannah R Murphy; Alyssa H Harris; Dhaval Kolte; Fuyuki Hirashima; Harold L Dauerman

doi:10.1016/j.jcin.2024.02.026

National Trends and Outcomes of Acute Myocardial Infarction After Transcatheter Aortic Valve Replacement

JACC Cardiovasc Interv. 2024 May 27;17(10):1267-1276. doi: 10.1016/j.jcin.2024.02.026. Epub 2024 Mar 25.

Authors

Tanush Gupta¹, Joshua Zimmer¹, Rony N Lahoud¹, Hannah R Murphy², Alyssa H Harris², Dhaval Kolte³, Fuyuki Hirashima⁴, Harold L Dauerman⁵

Affiliations

¹ Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, USA.
² Center for Advanced Analytics and Informatics, Vizient, Irving, Texas, USA.
³ Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴ Division of Cardiothoracic Surgery, University of Vermont Medical Center, Burlington, Vermont, USA.
⁵ Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, USA. Electronic address: harold.dauerman@uvmhealth.org.

PMID: 38530682
DOI: 10.1016/j.jcin.2024.02.026

Abstract

Background: Prior studies have reported decreased use of an invasive approach for acute myocardial infarction (AMI) in patients undergoing transcatheter aortic valve replacement (TAVR).

Objectives: The aim of this study was to determine whether prior TAVR affects the use of subsequent coronary revascularization and outcomes of AMI in a contemporary national data set.

Methods: Consecutive TAVR patients from 2016 to 2022 were identified from the U.S. Vizient Clinical Data Base who were hospitalized after the index TAVR hospitalization with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). Patients with STEMI or NSTEMI with or without prior TAVR from the same time period were compared for the use of coronary angiography, revascularization, and in-hospital outcomes. Propensity score matching was used to account for imbalances in patient characteristics.

Results: Among 206,229 patients who underwent TAVR, the incidence of STEMI was 25 events per 100,000 person-years of follow-up, and that of NSTEMI was 229 events per 100,000 person-years. After propensity matching, the use of coronary revascularization was similar in the prior TAVR and no TAVR cohorts in both the STEMI (65.3% vs 63.9%; P = 0.81) and NSTEMI (41.4% vs 41.7%; P = 0.88) subgroups. Compared with patients without prior TAVR, in-hospital mortality was higher in the prior TAVR cohort in patients with STEMI (27.1% vs 16.7%; P = 0.03) and lower in those with NSTEMI (5.8% vs 8.2%; P = 0.02).

Conclusions: In this large, national retrospective study, AMI events after TAVR were infrequent. There were no differences in the use of coronary revascularization for STEMI or NSTEMI in TAVR patients compared with the non-TAVR population. In-hospital mortality for STEMI is higher in TAVR patients compared with those without prior TAVR.

Keywords: acute myocardial infarction; coronary artery disease; mortality; revascularization; transcatheter aortic valve replacement.

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / mortality
Aortic Valve Stenosis* / physiopathology
Aortic Valve Stenosis* / surgery
Databases, Factual*
Female
Hospital Mortality*
Humans
Incidence
Male
Non-ST Elevated Myocardial Infarction* / diagnostic imaging
Non-ST Elevated Myocardial Infarction* / mortality
Non-ST Elevated Myocardial Infarction* / therapy
Percutaneous Coronary Intervention / adverse effects
Percutaneous Coronary Intervention / mortality
Percutaneous Coronary Intervention / trends
Retrospective Studies
Risk Assessment
Risk Factors
ST Elevation Myocardial Infarction* / diagnostic imaging
ST Elevation Myocardial Infarction* / mortality
ST Elevation Myocardial Infarction* / therapy
Time Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / mortality
Transcatheter Aortic Valve Replacement* / trends
Treatment Outcome
United States / epidemiology