NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK; University Gabriele D'Annunzio Chieti Pescara, Italy.
NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Int J Cardiol. 2022 Sep 1;362:14-19. doi: 10.1016/j.ijcard.2022.04.067. Epub 2022 Apr 27.
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.
非 ST 段抬高型心肌梗死（NIHR 健康信息学协作：TROP-CABG 研究）中肌钙蛋白升高对手术时间的影响。Benedetto 等人。
非 ST 段抬高型心肌梗死（NSTEMI）患者行冠状动脉旁路移植术（CABG）的最佳时机以及术前肌钙蛋白水平在决策中的作用仍不清楚。我们研究了（a）在一个大型 NSTEMI 患者队列中，术前峰值肌钙蛋白与 CABG 术后生存之间的关系，以及（b）肌钙蛋白与手术时间之间的相互作用。
我们的队列包括 1746 例患者（1684 例 NSTEMI；62 例不稳定型心绞痛）（平均年龄 69±11 岁，21%为女性），在 2010 年至 2017 年间，这 5 个英国中心记录了肌钙蛋白并进行了 CABG。使用时间分段 Cox 回归来研究峰值肌钙蛋白和手术时间对早期（30 天内）和晚期（30 天后）生存的相互作用。从峰值肌钙蛋白到手术的平均间隔为 9±15 天，其中 1466 例（84.0%）患者在同一住院期间进行了 CABG。30 天内有 60 例患者死亡，另外 211 例患者在平均随访 4±2 年后死亡（30 天生存率为 0.97±0.004，5 年生存率为 0.83±0.01）。峰值肌钙蛋白是早期生存的强烈预测因子（校正 P=0.002），与手术时间有显著的相互作用（P 交互=0.007）。对于肌钙蛋白水平低于正常值上限 100 倍的患者，较长的手术时间并不能提高早期生存率。然而，在肌钙蛋白较高的患者中，随着手术时间的延长，早期生存率逐渐增加，直到第 10 天。峰值肌钙蛋白对 30 天后的生存率没有影响（校正 P=0.64）。
NSTEMI 患者 CABG 前的峰值肌钙蛋白是早期死亡率的重要预测因子，对手术时间有强烈影响，并可能成为这些患者管理的一种有用的临床生物标志物。
