Abstract 19134: Elevated Troponin T is Associated with Adverse Outcomes After Aortic Valve Replacement

Abstract

Background: Data regarding association of elevated cardiac enzymes and adverse outcomes in patients who undergo aortic valve replacement (AVR) has been inconclusive. Role of coronary revascularization prior to AVR remains uncertain. We sought to understand prognostic implication of post procedure troponin T (TnT) elevation in patients undergoing AVR. Hypothesis: We hypothesized that patients with significantly elevated TnT after AVR will have worse outcomes representing important coronary circulation which is not revascularized. Methods: We retrospectively studied 4648 consecutive patients who underwent AVR at a single tertiary care center between January 2007 and December 2013. These were divided into surgical AVR (SAVR) and transcatheter AVR (TAVR). Median post procedure peak TnT was identified in the SAVR and TAVR groups. Patients were divided into quartiles based on median TnT level. Results: Of 4648 patients who underwent AVR, 4200 (66% male) were SAVR and 448 (59% male) were TAVR. Median post procedure peak TnT values in the TAVR and SAVR group were 0.19 [0.08-0.39] & 0.36 [0.22-0.64] respectively (p<0.001). 6 month mortality was 1.5% (65/4200) in SAVR cases and 2.7% (12/448) in TAVR cases (p=0.08). In patients with TnT less than 50 th percentile, 6 month mortality was 0.7% & 1.8% after SAVR & TAVR respectively (p=0.1). In patients with TnT higher than 50 th percentile, 6 month mortality was 2.4% & 3.6% after SAVR & TAVR respectively (p=0.26). In the SAVR group, mortality was 0.7% in patients with TnT levels less than 50 th percentile & 2.4% in patients with TnT higher than 50 th percentile (p<0.001). See Figure. Conclusion: Peak troponin T was significantly higher after SAVR as compared to TAVR. Higher post procedure peak TnT is associated with increased 6 month mortality. These results are highly significant in the SAVR group. The mechanism and significance of these findings requires further studies.