Proportional troponin changes and risk for outcomes with intervention strategies in non-ST-elevation acute coronary syndrome across kidney function

Roy O. Mathew, Division of Nephrology, Department of Medicine, Loma Linda VA Healthcare System, Loma Linda, California, USA.
Janani Rangaswami, Division of Nephrology, Department of Medicine, Washington DC VA Medical Center, Washington, District of Columbia, USA.
Dmitry Abramov, Division of Cardiology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA.
Gauranga Mahalwar, Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Shaitalya Vellanki, Department of Medicine, George Washington University School of Medicine, Washington, District of Columbia, USA.
Farah Abuazzam, Division of Nephrology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA.
Gary E. Fraser, Division of Cardiology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA.
Fayth Miles Butler, Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California, USA.
Kevin Bryan Lo, Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Charles A. Herzog, Cardiology Division, Department of Internal Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA.
Gautam R. Shroff, Cardiology Division, Department of Internal Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA.
Mandeep S. Sidhu, Division of Cardiology, Department of Medicine, Albany Medical College, Albany, New York, USA.
Sripal Bangalore, Division of Cardiology, New York University Grossman School of Medicine, New York City, New York, USA.

Document Type

Journal Article

Publication Date

12-1-2023

Journal

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

Volume

102

Issue

7

DOI

10.1002/ccd.30863

Keywords

acute coronary syndrome; cardiac troponin; chronic kidney disease; coronary artery bypass grafting; non-ST-elevation myocardial infarction; percutaneous coronary intervention

Abstract

AIMS: This analysis evaluates whether proportional serial cardiac troponin (cTn) change predicts benefit from an early versus delayed invasive, or conservative treatment strategies across kidney function in non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: Patients diagnosed with NSTE-ACS in the Veterans Health Administration between 1999 and 2022 were categorized into terciles (<20%, 20 to ≤80%, >80%) of proportional change in serial cTn. Primary outcome included mortality or rehospitalization for myocardial infarction at 6 and 12 months, in survivors of index admission. Adjusted hazard ratio (HR) with 95% confidence Intervals (95% confidence interval [CI]) were calculated for the primary outcome for an early invasive (≤24 h of the index admission), delayed invasive (>24 h of index admission to 90-days postdischarge), or a conservative management. RESULTS: Chronic kidney disease (CKD) was more prevalent (45.3%) in the lowest versus 42.2% and 43% in middle and highest terciles, respectively (p < 0.001). Primary outcome is more likely for conservative versus early invasive strategy at 6 (HR: 1.44, 95% CI: 1.37-1.50) and 12 months (HR: 1.44, 95% CI: 1.39-1.50). A >80% proportional change demonstrated HR (95% CI): 0.90 (0.83-0.97) and 0.93 (0.88-1.00; p = 0.041) for primary outcome at 6 and 12 months, respectively, when an early versus delayed invasive strategy was used, across CKD stages. CONCLUSIONS: Overall, the invasive strategy was safe and associated with improved outcomes across kidney function in NSTE-ACS. Additionally, >80% proportional change in serial troponin in NSTE-ACS is associated with benefit from an early versus a delayed invasive strategy regardless of kidney function. These findings deserve confirmation in randomized controlled trials.

Department

Medicine

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