Biomarkers to Predict Outcomes after Transcatheter Aortic Valve Implantation

Background: Prediction of postoperative outcomes after aortic valve intervention is challenging. Besides established risk stratification tools (e.g., EuroSCORE, STS-Score), preprocedural determination of biomarkers gains increasing importance and may be helpful to estimate postprocedural adverse outcomes. To further elucidate this topic, we herein aimed to correlate preprocedural biomarkers with postoperative outcomes after transcatheter aortic valve implantation (TAVI).

Methods: Patients undergoing TAVI were prospectively imputed into a dedicated registry. Valve-in-valve procedures were excluded from analysis. Preoperative circulating blood biomarkers, including hemoglobin, creatinine, troponin, GOT, GPT, INR, CRP, and NT-proBNP, were tested at baseline and except for hemoglobin log-transformed due to skew distributions. Logistic regression analysis adjusted for EuroSCORE-II tested associations between biomarkers and VARC-III adjudicated endpoints.

Results: Between 03/2008 and 06/2024, 3,687 consecutive patients (median age 81.3 [IQR 76.7, 84.9], median EuroSCORE II 4.5 [IQR 2.5, 8.2]) met inclusion criteria and were analyzed. Overall 30-day mortality was 6.2% (n = 218). Postprocedural stroke was found in 4.2% (n = 138). The postprocedural pacemaker implantation rate was 15.7% (n = 564). The combined 30-day VARC-3 endpoint clinical efficacy was reached in 78.8%. Preoperative hemoglobin (OR 0.91; 95% CI: 0.85, 0.99; p = 0.020), creatinine (OR 1.42; 95% CI: 1.09, 1.86; p = 0.010), troponin (OR 1.37; 95% CI: 1.07, 1.75; p = 0.011), CRP (OR 1.50; 95% CI: 1.19, 1.89; p < 0.001), and NT-proBNP (OR 1.58; 95% CI: 1.15, 2.18; p = 0.005) were all significant and independent predictors for 30-day mortality. Furthermore, all these biomarkers predicted acute kidney injury (AKI). None of the tested biomarkers independently correlated with type 3/4 bleeding or postoperative stroke.

Conclusion: This analysis identified several biomarkers that, independently from EuroSCORE II risk stratification, predict adverse outcomes after TAVI in terms of mortality and AKI. We cautiously assume that these biomarkers may indicate baseline cardiac and/or end-organ injury. Combined stratification models of these biomarkers with EuroSCORE II should be evaluated in further studies to improve predictive value.

Publication History

Article published online:
11 February 2025