PLoS ONE (Jan 2023)

Contrasting the potential benefits of early invasive coronary angiography in acute and chronic myocardial injury patterns.

  • Joanne Eng-Frost,
  • Simon Rocheleau,
  • Kristina Lambrakis,
  • Ehsan Khan,
  • Anke van den Merkhof,
  • Cynthia Papendick,
  • Sam Lehman,
  • Brian Chiang,
  • Naomi Wattchow,
  • Simon Steele,
  • Scott Lorensini,
  • Michael McCann,
  • Kate George,
  • Julian Vaile,
  • Carmine De Pasquale,
  • John French,
  • Derek Chew

DOI
https://doi.org/10.1371/journal.pone.0286157
Journal volume & issue
Vol. 18, no. 6
p. e0286157

Abstract

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BackgroundIn 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.MethodsUsing 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 'non-dynamic hs-cTnT elevation' (chronic myocardial injury). Patients with hs-cTnT ResultsAltogether, 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; pConclusionEarly 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.