Produção Nacional
Revisado por pares
ST-Segment Elevation Myocardial Infarction Following Transcatheter Aortic Valve Replacement
2021; Elsevier BV; Volume: 77; Issue: 17 Linguagem: Inglês
10.1016/j.jacc.2021.03.014
ISSN1558-3597
AutoresLaurent Faroux, Thibault Lhermusier, Flavien Vincent, Luis Nombela‐Franco, Didier Tchetchè, Marco Barbanti, Mohamed Abdel‐Wahab, Stephan Windecker, Vincent Auffret, Diego Carter Campanha‐Borges, Quentin Fischer, Érika Muñoz-García, Ramiro Trillo, Troels Højsgaard Jørgensen, Viçens Serra, Stefan Toggweiler, Giuseppe Tarantini, Francesco Saia, Éric Durand, Pierre Donaint, Enrique Gutiérrez, Harindra C. Wijeysundera, Gabriela Veiga Fernández, Giuseppe Patti, Fabrizio D’Ascenzo, Raúl Moreno, Christian Hengstenberg, Chekrallah Chamandi, Lluís Asmarats, Rosana Hernández‐Antolín, Joan Antoni Gómez‐Hospital, Juan G. Córdoba-Soriano, Uri Landes, Víctor Alfonso Jiménez Díaz, Ignacio Cruz‐González, Mohammed Nejjari, François Roubille, Éric Van Belle, Germán Armijo, Saifullah Siddiqui, Giuliano Costa, Sameh Elsaify, Thomas Pilgrim, Hervé Breton, Marina Ureña, Antonio J. Muñoz-García, Lars Søndergaard, Montserrat Bach-Oller, Chiara Fraccaro, Hélène Eltchaninoff, Damien Metz, María Tamargo, Víctor Fradejas-Sastre, Andrea Rognoni, Francesco Bruno, Georg Goliasch, Marcelo Santaló-Corcoy, Jesús Jiménez‐Mazuecos, John G. Webb, Guillem Muntané‐Carol, Jean-Michal Paradis, Antonio Mangieri, Henrique Barbosa Ribeiro, Francisco Campelo‐Parada, Josep Rodés‐Cabau,
Tópico(s)Coronary Interventions and Diagnostics
ResumoAmong patients with acute coronary syndrome following transcatheter aortic valve replacement (TAVR), those presenting with ST-segment elevation myocardial infarction (STEMI) are at highest risk. The goal of this study was to determine the clinical characteristics, management, and outcomes of STEMI after TAVR. This was a multicenter study including 118 patients presenting with STEMI at a median of 255 days (interquartile 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. 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. 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.
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