TY - JOUR
T1 - Contrasting the potential benefits of early invasive coronary angiography in acute and chronic myocardial injury patterns
AU - Eng-Frost, Joanne
AU - Rocheleau, Simon
AU - Lambrakis, Kristina
AU - Khan, Ehsan
AU - van den Merkhof, Anke
AU - Papendick, Cynthia
AU - Lehman, Sam
AU - Chiang, Brian
AU - Wattchow, Naomi
AU - Steele, Simon
AU - Lorensini, Scott
AU - McCann, Michael
AU - George, Kate
AU - Vaile, Julian
AU - De Pasquale, Carmine
AU - French, John
AU - Chew, Derek
PY - 2023/6/15
Y1 - 2023/6/15
N2 - Background In cases of evolving myocardial injury not definitively attributed to coronary ischaemia precipitated by plaque rupture, referral for invasive coronary angiography (ICA) may be influenced by observed troponin profiles. We sought to explore association between early ICA and elevated high-sensitivity troponin T (hs-cTnT) concentrations with and without dynamic changes, to examine if there may be a hs-cTnT threshold associated with benefit from an initial ICA strategy. Methods Using published studies (hs-cTnT study n = 1937, RAPID-TnT study n = 3270) and the Fourth Universal Definition of Myocardial Infarction (MI), index presentations of patients with hs-cTnT concentrations 5-14ng/L were classified as 'non-elevated' (NE). Hs-cTnT greater than upper reference limit (14ng/L) were classified as 'elevated hs-cTnT with dynamic change' (encompassing acute myocardial injury, Type 1 MI, and Type 2 MI), or 'nondynamic hs-cTnT elevation' (chronic myocardial injury). Patients with hs-cTnT <5ng/L and/ or eGFR<15mmol/L/1.73m2 were excluded. ICA was performed within 30 days of admission. Primary outcome was defined as composite endpoint of death, MI, or unstable angina at 12 months. Results Altogether, 3620 patients comprising 837 (23.1%) with non-dynamic hs-cTnT elevations and 332 (9.2%) with dynamic hs-cTnT elevations were included. Primary outcome was significantly higher with dynamic and non-dynamic hs-cTnT elevations (Dynamic: HR: 4.13 95%CI:2.92-5.82; p<0.001 Non-dynamic: HR: 2.39 95% confidence interval [CI]:1.74-3.28, p<0.001). Hs-cTnT thresholds where benefit from initial ICA strategy appeared to emerge was observed at 110ng/L and 50ng/L in dynamic and non-dynamic elevations, respectively. Conclusion Early ICA appears to portend benefit in hs-cTnT elevations with and without dynamic changes, and at lower hs-cTnT threshold in non-dynamic hs-cTnT elevation. Differences compel further investigation.
AB - Background In cases of evolving myocardial injury not definitively attributed to coronary ischaemia precipitated by plaque rupture, referral for invasive coronary angiography (ICA) may be influenced by observed troponin profiles. We sought to explore association between early ICA and elevated high-sensitivity troponin T (hs-cTnT) concentrations with and without dynamic changes, to examine if there may be a hs-cTnT threshold associated with benefit from an initial ICA strategy. Methods Using published studies (hs-cTnT study n = 1937, RAPID-TnT study n = 3270) and the Fourth Universal Definition of Myocardial Infarction (MI), index presentations of patients with hs-cTnT concentrations 5-14ng/L were classified as 'non-elevated' (NE). Hs-cTnT greater than upper reference limit (14ng/L) were classified as 'elevated hs-cTnT with dynamic change' (encompassing acute myocardial injury, Type 1 MI, and Type 2 MI), or 'nondynamic hs-cTnT elevation' (chronic myocardial injury). Patients with hs-cTnT <5ng/L and/ or eGFR<15mmol/L/1.73m2 were excluded. ICA was performed within 30 days of admission. Primary outcome was defined as composite endpoint of death, MI, or unstable angina at 12 months. Results Altogether, 3620 patients comprising 837 (23.1%) with non-dynamic hs-cTnT elevations and 332 (9.2%) with dynamic hs-cTnT elevations were included. Primary outcome was significantly higher with dynamic and non-dynamic hs-cTnT elevations (Dynamic: HR: 4.13 95%CI:2.92-5.82; p<0.001 Non-dynamic: HR: 2.39 95% confidence interval [CI]:1.74-3.28, p<0.001). Hs-cTnT thresholds where benefit from initial ICA strategy appeared to emerge was observed at 110ng/L and 50ng/L in dynamic and non-dynamic elevations, respectively. Conclusion Early ICA appears to portend benefit in hs-cTnT elevations with and without dynamic changes, and at lower hs-cTnT threshold in non-dynamic hs-cTnT elevation. Differences compel further investigation.
KW - Heart disease
KW - Angiography
KW - Myocardial injury
UR - http://www.scopus.com/inward/record.url?scp=85163362889&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1024008
UR - http://purl.org/au-research/grants/NHMRC/1124471
U2 - 10.1371/journal.pone.0286157
DO - 10.1371/journal.pone.0286157
M3 - Article
C2 - 37319181
AN - SCOPUS:85163362889
SN - 1932-6203
VL - 18
JO - PLoS One
JF - PLoS One
IS - 6
M1 - e0286157
ER -