TY - JOUR

T1 - ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement

AU - Faroux, Laurent

AU - Lhermusier, Thibault

AU - Vincent, Flavien

AU - Nombela-Franco, Luis

AU - Tchetche, Didier

AU - Barbanti, Marco

AU - Abdel-Wahab, Mohamed

AU - Windecker, Stephan

AU - Auffret, Vincent

AU - Campanha-Borges, Diego Carter

AU - Fischer, Quentin

AU - Munoz-Garcia, Erika

AU - Trillo-Nouche, Ramiro

AU - Jorgensen, Troels

AU - Serra, Vicens

AU - Toggweiler, Stefan

AU - Tarantini, Giuseppe

AU - Saia, Francesco

AU - Durand, Eric

AU - Donaint, Pierre

AU - Gutierrez-Ibanes, Enrique

AU - Wijeysundera, Harindra C.

AU - Veiga, Gabriela

AU - Patti, Giuseppe

AU - D'Ascenzo, Fabrizio

AU - Moreno, Raul

AU - Hengstenberg, Christian

AU - Chamandi, Chekrallah

AU - Asmarats, Lluis

AU - Hernandez-Antolin, Rosana

AU - Antoni Gomez-Hospital, Joan

AU - Gabriel Cordoba-Soriano, Juan

AU - Landes, Uri

AU - Alfonso Jimenez-Diaz, Victor

AU - Cruz-Gonzalez, Ignacio

AU - Nejjari, Mohammed

AU - Roubille, Francois

AU - Van Belle, Eric

AU - Armijo, German

AU - Siddiqui, Saifullah

AU - Costa, Giuliano

AU - Elsaify, Sameh

AU - Pilgrim, Thomas

AU - le Breton, Herve

AU - Urena, Marina

AU - Jesus Munoz-Garcia, Antonio

AU - Sondergaard, Lars

AU - Bach-Oller, Montserrat

AU - Fraccaro, Chiara

AU - Eltchaninoff, Helene

AU - Metz, Damien

AU - Tamargo, Maria

AU - Fradejas-Sastre, Victor

AU - Rognoni, Andrea

AU - Bruno, Francesco

AU - Goliasch, Georg

AU - Santalo-Corcoy, Marcelo

AU - Jimenez-Mazuecos, Jesus

AU - Webb, John G.

AU - Muntane-Carol, Guillem

AU - Paradis, Jean-Michal

AU - Mangieri, Antonio

AU - Barbosa Ribeiro, Henrique

AU - Campelo-Parada, Francisco

AU - Rodes-Cabau, Josep

PY - 2021/5/4

Y1 - 2021/5/4

N2 - 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 (inter quartile 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. (J Am Coll Cardiol 2021;77:2187-99)(c) 2021 by the American College of Cardiology Foundation.

AB - 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 (inter quartile 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. (J Am Coll Cardiol 2021;77:2187-99)(c) 2021 by the American College of Cardiology Foundation.

KW - mortality

KW - percutaneous coronary intervention

KW - ST-segment elevation myocardial infarction

KW - transcatheter aortic valve replacement

KW - acute coronary syndrome

KW - ACUTE CORONARY SYNDROME

KW - FRENCH REGISTRY

KW - MANAGEMENT

KW - IMPACT

KW - OUTCOMES

KW - OSTIA

U2 - 10.1016/j.jacc.2021.03.014

DO - 10.1016/j.jacc.2021.03.014

M3 - Journal article

C2 - 33926655

VL - 77

SP - 2187

EP - 2199

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 17

ER -