International Journal of Cardiovascular ResearchISSN: 2324-8602

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Research Article, Int J Cardiovasc Res Vol: 4 Issue: 6

The Prognostic Significance of Elevated Troponin Levels in Patients with Normal Coronaries Undergoing Surgery for Aortic Valve Stenosis

David Bleetman, Steven Law and Dumbor Ngaage*
The Essex Cardiothoracic Centre, Basildon University Hospital NHS Foundation Trust, Basildon, Essex SS16 5NL, United Kingdom
Corresponding author : Dumbor Ngaage
The Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, Essex SS16 5NL, United Kingdom
Tel: (+44) 1268 524900/4103; Fax: (+44) 1268 394334
E-mail: [email protected]
Received: January 07, 2015 Accepted: July 22, 2015 Published: July 25, 2015
Citation: Bleetman D, Law S, Ngaage D (2015) The Prognostic Significance of Elevated Troponin Levels in Patients with Normal Coronaries Undergoing Surgery for Aortic Valve Stenosis. Int J Cardiovasc Res 4:6. doi:10.4172/2324-8602.1000233

Abstract

The Prognostic Significance of Elevated Troponin Levels in Patients with Normal Coronaries Undergoing Surgery for Aortic Valve Steno

Objective: The outcome of aortic valve replacement (AVR) in patients without occlusive coronary artery disease who present with raised pre-operative troponin is not clear. We therefore, investigated the operative mortality and morbidity in this subset of patients undergoing urgent surgery for aortic stenosis.

Methods: From a pool of 595 AVR patients in our institution’s database from July 2007 to July 2013, we reviewed the notes of all patients who underwent urgent surgery for aortic stenosis (n=57) and identified those with raised pre-operative troponin (n=16). We compared the observed operative mortality and major morbidity rates between patients with raised preoperative troponin levels (group I) and those with normal troponin levels (group II), and also with their predicted outcomes.

Results: The baseline and operative characteristics for the two groups were comparable. There was a trend towards higher operative mortality for group I patients (18.8% versus 7.3% for group II, P=.07). Whereas, the observed operative mortality for group I far exceeded the predicted (18.8% vs 12.5%, p=.05), for group II the observed was slightly lower than the predicted operative mortality (7.3% vs 9.3%, p=.63). On the other hand, the observed mortality was well below the predicted for the elective patients.

Conclusion: Patients with aortic stenosis and raised preoperative troponin undergoing urgent AVR may be at risk of higher operative mortality than predicted by the EuroScore. Further studies in this high risk group are warranted.

Keywords: Aortic valve stenosis; Urgent presentation; Cardiac troponin; Aortic valve replacement; Operative mortality; Operative morbidity; Operative risk prediction

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