REVIEW  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2020 February;61(1):98-106

DOI: 10.23736/S0021-9509.19.11023-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Meta-analysis of impact of troponins on mortality after transcatheter aortic valve implantation

Hisato TAKAGI ^{1, 2} ✉, Yosuke HARI ^{1, 2}, Kouki NAKASHIMA ^{1, 2}, Toshiki KUNO ³, Tomo ANDO ⁴, on behalf of the All-Literature Investigation of Cardiovascular Evidence (ALICE) Group

¹ Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; ² Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan; ³ Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA; ⁴ Department of Cardiology, Detroit Medical Center, Detroit, MI, USA

INTRODUCTION: To determine whether troponin (Tn) can predict mortality after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of currently available studies investigating impact of baseline and postprocedural Tn.
EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through April 2019 using PubMed and OVID. Studies considered for inclusion met the following criteria: the study investigating impact of baseline and postprocedural Tn on mortality; the study population was patients undergoing TAVI for aortic stenosis (AS); outcomes included early (30-day or in-hospital)/late (including early) mortality. For each study, data regarding early/late mortality in both high and low (defined in each study) level of baseline/postprocedural Tn groups were used to generate odds ratios (ORs) and 95% confidence intervals (CIs), or reported ORs and hazard ratios (HRs) with 95% CIs were directly extracted. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model.
EVIDENCE SYNTHESIS: We identified 19 eligible studies including a total of 7555 patients undergoing TAVI. Pooled analyses demonstrated associations of high levels of baseline Tn with statistically significant increases in both 30-day (P=0.002) and midterm mortality (P<0.00001), no correlation of high postprocedural Tn with 30-day mortality (P=0.13), and an association of high postprocedural Tn with a statistically significant increase in midterm mortality (P=0.002). High levels of baseline/postprocedural TnT predicted statistically significant increases in both 30-day (P=0.002/<0.0001) and midterm mortality (P<0.00001/0.0003).
CONCLUSIONS: Both baseline and postprocedural Tn, especially TnT, may predict mortality after TAVI for AS.

KEY WORDS: Meta-analysis; Mortality; Transcatheter aortic valve replacement; Troponins