Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study). (1st September 2022)

• Record Type: Journal Article
• Authors: Benedetto, Umberto; Sinha, Shubhra; Mulla, Abdulrahim; Glampson, Benjamin; Davies, Jim; Panoulas, Vasileios; Gautama, Sanjay; Papadimitriou, Dimitri; Woods, Kerrie; Elliott, Paul; Hemingway, Harry; Williams, Bryan; Asselbergs, Folkert W.; Melikian, Narbeh; Krasopoulos, George; Sayeed, Rana; Wendler, Olaf; Baig, Kamran; Chukwuemeka, Andrew; Angelini, Gianni D.; Sterne, Jonathan A.C.; Johnson, Tom; Shah, Ajay M.; Perera, Divaka; Patel, Riyaz S.; Kharbanda, Rajesh; Channon, Keith M.; Mayet, Jamil; Kaura, Amit
• Is Part Of: International journal of cardiology. Volume 362(2022)
• Page Start: 14
• Page End: 19
• Publication Date: 2022-09-01
• Subjects: Coronary artery bypass grafting -- Myocardial infarction -- Timing-to-surgery -- Troponin; NSTEMI Non-ST Elevation Myocardial Infarction -- UA Unstable Angina -- CABG Coronary artery bypass graft -- ICD International Classification of Diseases -- ULN Upper limit of normal -- LVSD Left ventricular systolic dysfunction -- COPD Chronic obstructive pulmonary disease; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.04.067
• Languages: English
• ISSNs: 0167-5273

Abstract

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. Highlights: In patients with NSTEMI undergoing CABG, pre-operative peak troponin level was a significant predictor of early mortality. The relationship between troponin level and mortality was influenced by timing of CABG. In patients with a pre-operative peak troponin >100 xULN, CABG within 10 days was associated with lower survival. The interaction between troponin, timing of surgery and mortality should be discussed with NSTEMI patients undergoing CABG.