Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study)
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 su...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| פורמט: | Conference item |
| שפה: | English |
| יצא לאור: |
Elsevier
2022
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| _version_ | 1826308215150739456 |
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| author | Benedetto, U Sinha, S Mulla, A Glampson, B Davies, J Panoulas, V Gautama, S Papadimitriou, D Woods, K Elliott, P Hemingway, H Williams, B Asselbergs, FW Melikian, N Krasopoulos, G Sayeed, R Wendler, O Baig, K Chukwuemeka, A Angelini, GD Sterne, JAC Johnson, T Shah, AM Perera, D Patel, RS Kharbanda, R Channon, KM Mayet, J Kaura, A |
| author_facet | Benedetto, U Sinha, S Mulla, A Glampson, B Davies, J Panoulas, V Gautama, S Papadimitriou, D Woods, K Elliott, P Hemingway, H Williams, B Asselbergs, FW Melikian, N Krasopoulos, G Sayeed, R Wendler, O Baig, K Chukwuemeka, A Angelini, GD Sterne, JAC Johnson, T Shah, AM Perera, D Patel, RS Kharbanda, R Channon, KM Mayet, J Kaura, A |
| author_sort | Benedetto, U |
| collection | OXFORD |
| description | 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.
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| first_indexed | 2024-03-07T07:16:10Z |
| format | Conference item |
| id | oxford-uuid:ff686f9f-fbdf-4def-a451-3bc4e1132d5f |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:16:10Z |
| publishDate | 2022 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:ff686f9f-fbdf-4def-a451-3bc4e1132d5f2022-07-29T10:57:34ZImplications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study)Conference itemhttp://purl.org/coar/resource_type/c_5794uuid:ff686f9f-fbdf-4def-a451-3bc4e1132d5fEnglishSymplectic ElementsElsevier2022Benedetto, USinha, SMulla, AGlampson, BDavies, JPanoulas, VGautama, SPapadimitriou, DWoods, KElliott, PHemingway, HWilliams, BAsselbergs, FWMelikian, NKrasopoulos, GSayeed, RWendler, OBaig, KChukwuemeka, AAngelini, GDSterne, JACJohnson, TShah, AMPerera, DPatel, RSKharbanda, RChannon, KMMayet, JKaura, ABackground 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. |
| spellingShingle | Benedetto, U Sinha, S Mulla, A Glampson, B Davies, J Panoulas, V Gautama, S Papadimitriou, D Woods, K Elliott, P Hemingway, H Williams, B Asselbergs, FW Melikian, N Krasopoulos, G Sayeed, R Wendler, O Baig, K Chukwuemeka, A Angelini, GD Sterne, JAC Johnson, T Shah, AM Perera, D Patel, RS Kharbanda, R Channon, KM Mayet, J Kaura, A Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study) |
| title | Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study) |
| title_full | Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study) |
| title_fullStr | Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study) |
| title_full_unstemmed | Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study) |
| title_short | Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study) |
| title_sort | implications of elevated troponin on time to surgery in non st elevation myocardial infarction nihr health informatics collaborative trop cabg study |
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