TY - JOUR
T1 - Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative
T2 - TROP-CABG study)
AU - Benedetto, Umberto
AU - Sinha, Shubhra
AU - Mulla, Abdulrahim
AU - Glampson, Benjamin
AU - Davies, Jim
AU - Panoulas, Vasileios
AU - Gautama, Sanjay
AU - Papadimitriou, Dimitri
AU - Woods, Kerrie
AU - Elliott, Paul
AU - Hemingway, Harry
AU - Williams, Bryan
AU - Asselbergs, Folkert W
AU - Melikian, Narbeh
AU - Krasopoulos, George
AU - Sayeed, Rana
AU - Wendler, Olaf
AU - Baig, Kamran
AU - Chukwuemeka, Andrew
AU - Angelini, Gianni D
AU - Sterne, Jonathan A C
AU - Johnson, Tom
AU - Shah, Ajay M
AU - Perera, Divaka
AU - Patel, Riyaz S
AU - Kharbanda, Rajesh
AU - Channon, Keith M
AU - Mayet, Jamil
AU - Kaura, Amit
N1 - Funding Information: AK is funded by a British Heart Foundation clinical research training fellowship ( FS/20/18/34972 ). JACS is funded by a NIHR Senior Investigator award ( NF-SI-0611-10168 ). AMS is funded by a British Heart Foundation Professorship ( CH/1999001/11735 ). PE and HH received Health Data Research (HDR) funding. RSP is funded by a British Heart Foundation intermediate fellowship ( FS/14/76/30933 ). JM is supported by the British Heart Foundation Imperial Centre for Research Excellence ( RE/18/4/34215 ). UB and GDA are supported by the British Heart Foundation and the Bristol NIHR Biomedical Research Centre. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2022 Elsevier B.V.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - 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.
AB - 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.
KW - Coronary artery bypass grafting
KW - Myocardial infarction
KW - Timing-to-surgery
KW - Troponin
UR - http://www.scopus.com/inward/record.url?scp=85130382885&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijcard.2022.04.067
DO - https://doi.org/10.1016/j.ijcard.2022.04.067
M3 - Article
C2 - 35487318
SN - 0167-5273
VL - 362
SP - 14
EP - 19
JO - International journal of cardiology
JF - International journal of cardiology
ER -