You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Evaluation of the Valve Academic Research Consortium-2 Criteria for Myocardial Infarction in Transcatheter Aortic Valve Implantation: A Prospective Observational Study
Abstract 1:
Objective To evaluate the relevance of the individual components of the Valve Academic Research Consortium (VARC)-2 criteria for periprocedural myocardial infa rct ion ( MI ) in  transcatheter aortic valve implantation ( TAVI ) . The association between biomarkers and adverse procedural outcome has been established . However , the additive prognostic importance of signs and symptoms are more uncertain . Methods A total of 125 consecutive TAVI patients were prospect ively included in this study . Biomarkers for MI were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records . Results The criteria of elevated biomarkers and of signs or symptoms were found in 27 ( 22 % ) and 32 ( 26 % ) of the patients , respectively . According to VARC-2 definition , 12 ( 10 % ) had MI . VARC-2 definition of MI , Troponin T ( TnT ) > 600 ng/L , and presence of signs or symptoms correlated with 6 months mortality , prolonged ICU stay , elevation of N-terminal prohormone brain natriuretic peptide , and renal impairment . No signs or symptoms were found in 7 ( 44 % ) of the patients who fulfilled the criterion of elevated TnT > 600 ng/L. In the group with positive TnT criterion , there were no significant differences between those with and without signs or symptoms in respect to levels of TnT ( 1014 [ 585–1720 ] ng/L versus 704 [ 515–905 ] ng/L , p = 0.17 ) or creatine kinase-MB ( 36 [ 25–52 ] μg/L versus 29 [ 25–39 ] μg/L , p = 0.32 ) . In the multivariate Cox regression analysis , TnT > 600 ng/L was the only significant independent variable associated with 6-months postprocedural mortality . Conclusions Myocardial injury in TAVI , measured with biomarkers , correlates well with adverse procedural outcome . In this study it is also the strongest predictor for early postprocedural mortality . The additional requirement of signs or symptoms for the diagnosis of MI results in omission of a considerable number of clinical ly significant MI


Title 2:
Preprocedural but not periprocedural high-sensitive Troponin T levels predict outcome in patients undergoing transcatheter aortic valve implantation.
Abstract 2:
AIM Risk assessment of patients undergoing transcatheter aortic valve implantation ( TAVI )  remains difficult . Biomarkers have been shown to provide potential prognostic information . Here , we aim ed to analyze whether the biomarker high-sensitivity Troponin T ( hsTNT ) could be used to improve risk stratification . METHOD We prospect ively enrolled 267 patients undergoing TAVI . Biomarkers ( hsTNT and NTproBNP ) were measured 1 day before , and 3 and 7 days postprocedure . All possible prognostic factors upon survival time were analyzed by Cox regression analysis . RESULTS A total of 259 patients ( mean age 82±6.1 years ) were available for complete follow-up . The median Logistic EuroSCORE ( Log ES ) and Log ES II were 21.16 % ( Q1=13.92 ; Q3=34.27 ) and 6.42 % ( Q1=3.89 ; Q3=11.07 ) , respectively . Median follow-up was 290 ( Q1=88 ; Q3=529 ) days . A total of 71 deaths occurred during follow-up , and the 30-day mortality was 5.8 % . Median baseline hsTNT was 27.4 pg/mL ( Q1=16.2 ; Q3=46 pg/mL ) . From all potential mortality-associated factors , only preprocedural hsTNT level ( P=.001 ) , elevated Log ES ( P=.03 ) as well as acute kidney injury ( P<.001 ) and chronic obstructive pulmonary disease ( COPD ) ( P=.039 ) emerged as independent prognostic parameters for adverse outcome . We also tested whether the Valve Academic Research Consortium-2 ( VARC-II ) cutoff for myocardial damage ( hsTNT peak value exceeding 15 × the upper reference limit + at least 50 % increase ) was of prognostic relevance . At 72-hours post-TAVI , 36.2 % of the patients matched these VARC-II criteria of myocardial damage . However , these patients did not display a difference in survival compared to patients without significant myocardial injury . CONCLUSION Elevated preprocedural hsTNT represents an independent risk predictor of all-cause death while periprocedural hsTNT elevation failed to show prognostic relevance


Title 3:
Remote Ischemic Preconditioning Improves Outcome at 6 Years After Elective Percutaneous Coronary Intervention: The CRISP Stent Trial Long-term Follow-up
Abstract 3:
Background —Postprocedural myocardial infa rct ion ( type 4a ) has been shown to be an adverse prognostic indicator after  elective percutaneous coronary intervention ( PCI ) . The Cardiac Remote Ischemic Preconditioning in Coronary Stenting ( CRISP Stent ) study demonstrated that remote ischemic preconditioning reduced procedural symptoms , ECG ST-segment deviation , and cardiac troponin I release after elective PCI and reduced the major adverse cardiac and cerebral event ( MACCE ) rate at 6 months . We were interested to confirm if this early benefit in MACCE rate in the remote ischemic preconditioning group was sustained long-term . Methods and Results — Patients were telephoned by research ers blinded to the r and omization details . MACCE , defined as all-cause mortality , nonfatal myocardial infa rct ion , transient ischemic attack or stroke , and heart failure requiring hospital admission , were adjudicated by case note and national data base review . One hundred ninety-two ( 89.3 % ) of the 225 patients with elective PCI r and omized in the original study were available for long-term follow-up ( mean time to event or last follow-up : 1579.7±603.6 days ) . There were a total of 59 ( 30.7 % ) MACCEs . Patients with an MACCE had a higher mean cardiac troponin I after PCI ( ±SD ) : 2.07±6.99 versus 0.91±2.07 ng/mL ( P=0.05 ) . The MACCE rate at 6 years remained lower in the remote ischemic preconditioning group ( hazard ratio , 0.58 ; 95 % confidence interval , 0.35–0.97 ; P=0.039 ; absolute risk reduction=0.13 and number needed to treat=8 to prevent the MACCE at 6 years ) . Conclusions —Remote ischemic preconditioning reduces the incidence of postprocedural cardiac troponin I after elective PCI and confers an MACCE-free survival benefit at both short- and long-term follow-up . Clinical Trial Registration —URL : http://www.ukcrn.org.uk . Unique identifier : UKCRN


Title 4:
ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions
Abstract 4:
Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies


Title 5:
Preserved prognostic value of preinterventional troponin T levels despite successful TAVI in patients with severe aortic stenosis
Abstract 5:
Background Elevated concentrations of troponin T have prognostic impact in patients with various cardiovascular diseases including those with severe aortic stenosis .  Transcatheter aortic valve implantation ( TAVI ) has improved prognosis for patients without a surgical option . Whether this affects the prognostic value of preinterventional troponin T remains unclear . Methods We therefore conducted a prospect i ve study in 198 consecutive patients with subsequent , successful transfemoral TAVI  and analyzed cardiac troponin T ( cTnT ) levels with a new generation , high-sensitive troponin T assay before and after TAVI , as well as their prognostic value after 12 months . Results Patients with severe aortic stenosis ( AS ) showed significant elevation of preinterventional cTnT levels . Postinterventional cTnT levels significantly rose further about sevenfold after transfemoral TAVI and peaked at day three until they steadily declined thereafter . Baseline renal function ( P = 0.011 ) , the duration of intraprocedural rapid pacing ( P = 0.0012 ) , and baseline cTnT ( P = 0.0001 ) values predicted the magnitude of postinterventional cTnT elevations . Interestingly , Kaplan – Meier curve analysis revealed , that although cTnT levels were not predictive for short-term mortality , preinterventional as well as postinterventional peak cTnT showed prognostic value for 1-year mortality , regardless of successful TAVI . Conclusions Pre- and postinterventional hscTnT levels signal adverse 1-year mortality in patients with severe AS independent of successful aortic valve replacement


Title 6:
Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients.
Abstract 6:
BACKGROUND Previous trials have shown that among high-risk patients with aortic stenosis , survival rates are similar with transcatheter aortic-valve replacement ( TAVR ) and surgical aortic-valve replacement . We evaluated the two procedures in a r and omized trial involving intermediate-risk patients . METHODS We r and omly assigned 2032 intermediate-risk patients with severe aortic stenosis , at 57 centers , to undergo either TAVR or surgical replacement . The primary end point was death from any cause or disabling stroke at 2 years . The primary hypothesis was that TAVR would not be inferior to surgical replacement . Before r and omization , patients were entered into one of two cohorts on the basis of clinical and imaging findings ; 76.3 % of the patients were included in the transfemoral-access cohort and 23.7 % in the transthoracic-access cohort . RESULTS The rate of death from any cause or disabling stroke was similar in the TAVR group and the surgery group ( P=0.001 for noninferiority ) . At 2 years , the Kaplan-Meier event rates were 19.3 % in the TAVR group and 21.1 % in the surgery group ( hazard ratio in the TAVR group , 0.89 ; 95 % confidence interval [ CI ] , 0.73 to 1.09 ; P=0.25 ) . In the transfemoral-access cohort , TAVR result ed in a lower rate of death or disabling stroke than surgery ( hazard ratio , 0.79 ; 95 % CI , 0.62 to 1.00 ; P=0.05 ) , whereas in the transthoracic-access cohort , outcomes were similar in the two groups . TAVR result ed in larger aortic-valve areas than did surgery and also result ed in lower rates of acute kidney injury , severe bleeding , and new-onset atrial fibrillation ; surgery result ed in fewer major vascular complications and less paravalvular aortic regurgitation . CONCLUSIONS In intermediate-risk patients , TAVR was similar to surgical aortic-valve replacement with respect to the primary end point of death or disabling stroke . ( Funded by Edwards Lifesciences ; PARTNER 2 Clinical Trials.gov number , NCT01314313 . )


Title 7:
Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging.
Abstract 7:
OBJECTIVES The aim of this study was prospect i ve investigation of silent and clinical ly apparent cerebral embolic events and neurological impairment after  transfemoral aortic valve implantation ( TAVI ) .  BACKGROUND TAVI is a novel therapeutic approach for multimorbid patients with severe aortic stenosis . We investigated peri-interventional cerebral embolism with diffusion-weighted magnetic resonance imaging ( DW-MRI ) and its relationship to clinical and serologic parameters of brain injury . METHODS Cerebral DW-MRI was performed before , directly , and 3 months after  TAVI  with the current third-generation self-exp and ing CoreValve ( Medtronic , Minneapolis , Minnesota ) prosthesis . At the timepoints of the serial MRI studies , focal neurological impairment was assessed according to the National Institutes of Health Stroke Scale ( NIHSS ) , and serum concentration of neuron-specific enolase ( NSE ) , a marker of the volume of brain tissue involved in an ischemic event , were determined . RESULTS Thirty patients were enrolled ; 22 completed the imaging protocol . Three patients ( 10 % ) had new neurological findings after TAVI , of whom only 1 ( 3.6 % ) had a permanent neurological impairment . Of the 22 TAVI patients with complete imaging data , 16 ( 72.7 % ) had 75 new cerebral lesions after TAVI presumed to be embolic . The NIHSS and NSE were not correlated with DW-MRI lesions . CONCLUSIONS The incidence of clinical ly silent peri-interventional cerebral embolic lesions after TAVI is high . However , in this cohort of 30 patients , the incidence of persistent neurological impairment was low . ( Incidence and Severity of Silent and Apparent Cerebral Embolism After Conventional and Minimal-invasive Transfemoral Aortic Valve Replacement ; NCT00883285 )
Conclusions : PPMI is common following TAVR and is strongly associated with 30-day and 1-year mortality .
Detection of PPMI has potential to identify TAVR patients at highest risk of subsequent adverse events