Insights into AMI Outcomes and National Trends After TAVR
The following is a summary of “National trends and outcomes of acute myocardial infarction after transcatheter aortic valve replacement,” published in the May 2024 issue of Cardiology by Gupta et al.
A previous study found that fewer patients undergo invasive acute myocardial infarction (AMI) treatment in patients undergoing transcatheter aortic valve replacement (TAVR).
Researchers conducted a retrospective study to determine how prior TAVR affects patients with coronary revascularization later and AMI outcomes in the national data set.
They looked at patients who underwent TAVR from 2016 to from the U.S. Vizient Clinical Database who were hospitalized for ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). Comparison between those with or without prior TAVR occurred for coronary angiography, revascularization, and in-hospital outcomes. Propensity score matching was used to account for imbalances in patients’ characteristics.
The results showed that in 206,229 patients who underwent TAVR, the incidence of STEMI was 25 events per 100,000 person-years of follow-up and 229 events per 100,000 person-years. After matching patients, similar rates of coronary revascularization for both groups in STEMI (65.3% vs. 63.9%, P=0.81) and NSTEMI (41.4% vs. 41.7%, P=0.88). In-hospital mortality was higher for prior TAVR patients with STEMI (27.1% vs. 16.7%, P=0.03) and lower for patients with NSTEMI (5.8% vs. 8.2%; P=0.02).
Investigators concluded that AMI events after TAVR were rare in this extensive study. No differences in revascularization procedures between patients with TAVR and others were observed. However, patients with TAVR had higher in-hospital mortality rates for STEMI than those without prior TAVR.