Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health
Umberto Benedetto1, Shubhra Sinha2, Abdulrahim Mulla3
1NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK; University Gabriele D'Annunzio Chieti Pescara, Italy.
Insights
Elevated troponin levels in non-ST elevation myocardial infarction (NSTEMI) predict early mortality after coronary artery bypass grafting (CABG). Higher troponin levels benefit from delayed surgery up to 10 days for improved survival.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Optimal timing for coronary artery bypass grafting (CABG) in non-ST elevation myocardial infarction (NSTEMI) remains unclear.
- The role of pre-operative troponin levels in guiding CABG timing is not well-defined.
Purpose of the Study:
- To investigate the association between peak pre-operative troponin levels and survival post-CABG in NSTEMI patients.
- To examine the interaction between troponin levels and time-to-surgery on patient outcomes.
Main Methods:
- Analysis of 1746 patients (1684 NSTEMI) who underwent CABG between 2010-2017.
- Time-segmented Cox regression to assess the interaction of peak troponin and time-to-surgery on early (30-day) and late survival.
- Evaluation of troponin levels relative to the upper limit of normal.
Main Results:
- Peak troponin was a significant predictor of early mortality (P=0.002) and interacted significantly with time-to-surgery (P=0.007).
- For troponin levels <100x upper limit of normal, longer time-to-surgery did not improve early survival.
- Higher troponin levels were associated with progressively increasing early survival up to 10 days post-peak troponin.
Conclusions:
- Peak troponin is a significant predictor of early mortality in NSTEMI patients undergoing CABG.
- Troponin levels influence the optimal timing of surgery, with higher levels benefiting from delayed intervention.
- Peak troponin may serve as a valuable biomarker for managing NSTEMI patients requiring CABG.
Abstract:
Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction(NIHR Health Informatics Collaborative:TROP-CABG study). Benedetto et al. BACKGROUND: The optimal timing of coronary artery bypass grafting (CABG) in patients with non-ST elevation myocardial infarction (NSTEMI) and the utility of pre-operative troponin levels in decision-making remains unclear. We investigated (a) the association between peak pre-operative troponin and survival post-CABG in a large cohort of NSTEMI patients and (b) the interaction between troponin and time-to-surgery. METHODS AND RESULTS: Our cohort consisted of 1746 patients (1684 NSTEMI; 62 unstable angina) (mean age 69 ± 11 years,21% female) with recorded troponins that had CABG at five United Kingdom centers between 2010 and 2017. Time-segmented Cox regression was used to investigate the interaction of peak troponin and time-to-surgery on early (within 30 days) and late (beyond 30 days) survival. Average interval from peak troponin to surgery was 9 ± 15 days, with 1466 (84.0%) patients having CABG during the same admission. Sixty patients died within 30-days and another 211 died after a mean follow-up of 4 ± 2 years (30-day survival 0.97 ± 0.004 and 5-year survival 0.83 ± 0.01). Peak troponin was a strong predictor of early survival (adjusted P = 0.002) with a significant interaction with time-to-surgery (P interaction = 0.007). For peak troponin levels <100 times the upper limit of normal, there was no improvement in early survival with longer time-to-surgery. However, in patients with higher troponins, early survival increased progressively with a longer time-to-surgery, till day 10. Peak troponin did not influence survival beyond 30 days (adjusted P = 0.64). CONCLUSIONS: Peak troponin in NSTEMI patients undergoing CABG was a significant predictor of early mortality, strongly influenced the time-to-surgery and may prove to be a clinically useful biomarker in the management of these patients.
More Related Videos
07:40Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training
Published on: October 10, 2019
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Angina V: Nursing Management