Abstract
Background: Transcatheter aortic valve replacement (TAVR) is currently the most commonly utilized management strategy for severe aortic stenosis. The short-term outcomes of TAVR in patients who experienced a recent acute myocardial infarction (AMI) remain unclear.
Methods: Using data from the National Readmissions Database years 2016 to 2020, we identified patients who underwent TAVR and had a recent AMI (either ST-elevation [STEMI] or non-ST-elevation myocardial infarction [NSTEMI]) and underwent percutaneous coronary intervention (PCI) within 90 days prior to the TAVR. The primary outcome assessed was in-hospital mortality. A multivariable logistic regression model adjusting for patient and hospital level characteristics was conducted.
Results: Among 113,300 patients who underwent TAVR, 2,033 (1.8%) had an AMI within 90 days prior to the TAVR. Compared with those who did not have a recent AMI, there was no significant difference in in-hospital mortality (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 0.62 - 1.99, P=0.72), stroke (aOR 1.22, CI 0.48 - 3.08, P=0.68), and valvular complications (aOR 0.98, CI 0.49 - 1.97, P=0.95). However, there was a higher incidence of major bleeding (aOR 1.97, CI 1.26 - 3.07, P=0.003) and acute kidney injury (aOR 1.86, CI 1.52 - 2.27, P<0.001). There was no difference in the outcomes based on the initial presentation (STEMI vs NSTEMI).
Conclusions: Among patients who are undergoing TAVR and had an AMI within 90 days, TAVR appears to be safe, and not associated with higher short-term mortality. However, these patients had a higher incidence of AKI and major bleeding.
Keywords
TAVR, Acute MI, STEMI, NSTEMI, Outcomes research, Aortic stenosis, Structural heart disease