Myocardial Injury Post Transcatheter Aortic Valve Implantation Comparing Mechanically Expanded Versus Self-Expandable Versus Balloon-Expandable Valves

Figures & data

Figure 1. Flowchart of the study population

Table 1. Baseline characteristics of the total patient population and per valve mechanism

	Total population	Mechanically expanded valve	Self-expandable valve	Balloon-expandable valve	P-value
	n = 1208	n = 144	n = 678	n = 386
Age (yrs), median (IQR)	84 (80–87)	82 (76–86)	85 (81–88)	84 (79–87)	<0.001
Female, n (%)	604 (50)	76 (53)	399 (59)	129 (33)	<0.001
Height (cm), median (IQR)	165 (158–170)	167 (159–172)	162 (155–168)	168 (160–172)	<0.001
Weight (kg), median (IQR)	70 (60–80)	75 (65–86)	68 (58–78)	74 (64–82)	<0.001
Body mass index (kg/m2), median (IQR)	25.6 (23.1–29.0)	26.6 (23.8–30.7)	25.3 (22.9–28.5)	25.8 (23.6–29.3)	0.001
New York Heart Association class ≥ III, n (%)	801 (66)	101 (70)	459 (68)	241 (62)	0.089
Previous myocardial infarction, n (%)	246 (20)	25 (17)	123 (18)	98 (25)	0.012
Previous coronary artery bypass graft surgery, n (%)	151 (13)	22 (15)	76 (11)	53 (14)	0.29
Previous percutaneous coronary intervention, n (%)	408 (34)	41 (29)	231 (34)	135 (35)	0.33
Diabetes mellitus, n (%)	329 (27)	56 (39)	173 (26)	100 (26)	0.004
Hypertension, n (%)	935 (77)	123 (85)	512 (76)	300 (78)	0.036
Peripheral vascular disease, n (%)	202 (17)	29 (20)	107 (16)	66 (17)	0.43
Pulmonary Hypertension, n (%)	243 (20)	21 (15)	142 (21)	80 (21)	0.21
Chronic obstructive pulmonary disease, n (%)	284 (24)	40 (28)	157 (23)	87 (23)	0.43
Atrial fibrillation, n (%)	262 (22)	40 (28)	136 (20)	86 (22)	0.12
Permanent pacemaker, n (%)	157 (13)	22 (15)	86 (13)	49 (13)	0.70
Laboratory results
Creatinine (umol/L), median (IQR)	102 (83–133)	104 (81–128)	101 (81–133)	103 (85–134)	0.25
GFR (ml/min), median (IQR)	43 (32–58)	47 (36–67)	41 (29–54)	46 (33–62)	<0.001
Hemoglobin (mmol/L), median (IQR)	7.8 (7.1–8.4)	7.8 (7.1–8.4)	7.8 (7.1–8.4)	7.8 (7.1–8.6)	0.23
Echocardiography
Left ventricular ejection fraction, median (IQR)	60 (45–65)	60 (49–65)	60 (46–65)	55 (43–63)	0.004
Mean gradient, median (IQR)	45 (35–54)	43 (35–52)	45 (36–55)	45 (34–53)	0.32
Logistic Euroscore, median (IQR)	17 (11–24)	13 (9–19)	18 (12–25)	16 (10–24)	<0.001

Table 2. Procedural characteristics of the total patient population and per valve mechanism

	Total population	Mechanically expanded valve	Self-expandable valve	Balloon-expandable valve	P-value
	n = 1208	n = 144	n = 678	n = 386
PCI work-up					0.009
Staged, n (%)	222 (18)	16 (12)	124 (19)	82 (22)	0.031
Concomitant PCI, n (%)	30 (3)	7 (6)	11 (2)	12 (4)	0.051
Pre-implantation balloon dilatation, n (%)	424 (35)	48 (33)	248 (37)	128 (33)	0.49
Post-implantation balloon dilatation, n (%)	234 (19)	0 (0)	192 (28)	42 (11)	<0.001
Pre- or post-balloon dilatation, n (%)	586 (49)	48 (33)	386 (57)	152 (39)	<0.001
Valve in Valve, n (%)	42 (4)	0 (0)	39 (6)	3 (1)	<0.001
Residual aortic regurgitation (Sellers) ≥ grade 2, n (%)	89 (7)	2 (1)	79 (12)	8 (2)	<0.001

Table 3. In-hospital complications of the total patient population and divided per valve mechanism

	Total population	Mechanically expanded valve	Self-expandable valve	Balloon-expandable valve	P-value
	n = 1208	n = 144	n = 678	n = 386
Myocardial infarction, n (%)	15 (1)	0 (0)	10 (1)	5 (1)	0.42
Cardiac tamponade, n (%)	12 (1)	3 (2)	6 (1)	3 (1)	0.33
Coronary obstruction, n (%)	3 (0.2)	0 (0)	2 (0.3)	1 (0.3)	1.00
Myocardial injury, n (%)	925 (77)	96 (67)	535 (79)	294 (76)	0.007
Difference hsTnT, median (IQR)	741 (228–1780)	335 (175–1167)	901 (274–1888)	649 (222–1671)	<0.001
Vascular complications					0.99
Major, n (%)	47 (4)	6 (4)	25 (4)	16 (4)
Minor, n (%)	123 (10)	13 (9)	70 (10)	40 (10)
Bleeding complications					0.67
Life-threatening, n (%)	34 (3)	5 (4)	20 (3)	9 (2)
Major, n (%)	39 (3)	7 (5)	23 (3)	9 (2)
Minor, n (%)	111 (9)	13 (9)	66 (10)	32 (8)
Conduction disorders
New LBBB, n (%)	187 (15)	60 (42)	92 (14)	35 (9)	<0.001
New PPI, n (%)	177 (15)	35 (24)	99 (15)	43 (11)	0.001

Notes. hsTnT, high sensitive Troponin T; LBBB, left bundle branch block; PPI, permanent pacemaker implantation.

Table 4. Multivariable logistic regression for the determination of peri-procedural myocardial injury

Determinants	OR (95% CI)	p-value
Age (years)	1.02 (0.99–1.04)	0.22
Female	0.85 (0.62–1.16)	0.31
BMI	1.00 (0.99–1.01)	0.96
Previous myocardial infarction	1.62 (1.04–2.56)	0.032
Previous PCI	0.90 (0.64–1.27)	0.56
Previous CABG	0.69 (0.44–1.10)	0.12
Atrial fibrillation at baseline	0.99 (0.69–1.41)	0.95
Diabetes mellitus	0.80 (0.58–1.10)	0.17
Hypertension	1.24 (0.88–1.74)	0.22
GFR (ml/min)	1.00 (0.99–1.00)	0.083
LVEF (%)	1.03 (1.01–1.04)	<0.001
Mean aortic gradient (mm Hg)	1.02 (1.01–1.03)	<0.001
Logistic EuroScore (%)	1.02 (1.00–1.03)	0.072
PCI work-up		0.004
Staged PCI	1.36 (0.88–2.10)	0.16
Concomitant PCI	0.32 (0.14–0.70)	0.004
Pre- or post-balloon dilatation	0.76 (0.56–1.03)	0.074
Non-MEV	1.63 (1.06–2.49)	0.025
Residual AR (Sellers) ≥ grade 2	0.72 (0.42–1.24)	0.24

Notes. BMI, body mass index; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; GFR, glomerular filtration rate; LVEF, left ventricular ejection fraction; MEV, mechanically expanded valve; AR, aortic regurgitation.

Figure 2. Kaplan–Meier curves for 30-day (a) all-cause and (b) cardiovascular mortality in the myocardial injury vs. no myocardial injury group