Patients who present with a ST-segment elevation myocardial infarction (STEMI) after undergoing transcatheter aortic valve replacement (TAVR) experience poor outcomes and high rates of percutaneous coronary intervention (PCI) failure, according to a new study published in the Journal of the American College of Cardiology.
The authors reviewed data from more than 42,000 TAVR patients overall, closing in on 118 who presented with a STEMI after the procedure. The mean patient age was approximately 80 years old, and the cohort was split evenly between men and women. The median time between STEMI and TAVR was 255 days. More than 86% of those patients were managed with primary PCI, 12.7% were managed medically and another 0.9% received pre-hospital thrombolysis. In-hospital mortality for this group was 25.4%.
The patients managed with primary PCI were then compared to another 439 individuals who underwent primary PCI at some of the same facilities, and at roughly the same time, though that group did not undergo TAVR.
Overall, the authors noted that the median door-to-balloon time, procedural time, fluoroscopy time, dose-area product and contrast volume were all longer/greater among the TAVR patients who underwent PCI than the non-TAVR patients treated with PCI. The long door-to-balloon time among TAVR patients was attributed, in part, to the various coronary access issues those individuals were already experiencing.
The team also observed that PCI failure—defined as a final diameter stenosis of more than 30% or a post-dilation Thrombosis in Myocardial Infarction flow grade of 0 or 1—was seen in 16.5% of patients who had undergone TAVR and just 3.9% of non-TAVR patients.
In-hospital mortality, meanwhile, was 20.6% among patients who underwent PCI after post-TAVR STEMI
“STEMI following TAVR is a rare event but associated with dismal in-hospital and midterm clinical outcomes,” wrote lead author Laurent Faroux, MD, of Laval University in Québec City, and colleagues. “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 PCI failure was strongly associated with an increased mortality risk. These results highlight the urgent need for a better understanding of coronary cannulation difficulties and the techniques for enhancing coronary access and improving PCI success rates and clinical outcomes in this population.”
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.