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

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...

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Published in:PloS one 2023-06, Vol.18 (6), p.e0286157-e0286157
Main Authors: Eng-Frost, Joanne, Rocheleau, Simon, Lambrakis, Kristina, Khan, Ehsan, van den Merkhof, Anke, Papendick, Cynthia, Lehman, Sam, Chiang, Brian, Wattchow, Naomi, Steele, Simon, Lorensini, Scott, McCann, Michael, George, Kate, Vaile, Julian, De Pasquale, Carmine, French, John, Chew, Derek
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Angina
Angina pectoris
Angiography
Angioplasty
Biology and Life Sciences
Cardiac patients
Cardiology
Coronary vessels
Diagnosis
Emergency medical care
Health care networks
Heart attack
Heart attacks
Heart diseases
Heart failure
Heart surgery
Injuries
Ischemia
Medical imaging
Medicine and Health Sciences
Mortality
Myocardial infarction
Research and Analysis Methods
Risk factors
Troponin
Troponin T
Veins & arteries
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Summary: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. 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 'non-dynamic hs-cTnT elevation' (chronic myocardial injury). Patients with hs-cTnT
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0286157