학술논문
Proportional troponin changes and risk for outcomes with intervention strategies in non-ST-elevation acute coronary syndrome across kidney function.
Document Type
Academic Journal
Author
Mathew RO; Division of Nephrology, Department of Medicine, Loma Linda VA Healthcare System, Loma Linda, California, USA.; Division of Nephrology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA.; Rangaswami J; Division of Nephrology, Department of Medicine, Washington DC VA Medical Center, Washington, District of Columbia, USA.; Department of Medicine, George Washington University School of Medicine, Washington, District of Columbia, USA.; Abramov D; Division of Cardiology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA.; Mahalwar G; Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Vellanki S; Department of Medicine, George Washington University School of Medicine, Washington, District of Columbia, USA.; Abuazzam F; Division of Nephrology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA.; Fraser GE; Division of Cardiology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA.; Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California, USA.; Adventist Health Study, Loma Linda University, Loma Linda, California, USA.; Department of Preventive Medicine, School of Medicine, Loma Linda University, Loma Linda, California, USA.; Butler FM; Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California, USA.; Adventist Health Study, Loma Linda University, Loma Linda, California, USA.; Department of Preventive Medicine, School of Medicine, Loma Linda University, Loma Linda, California, USA.; Lo KB; Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.; Department of Medicine, Sydney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.; Herzog CA; Cardiology Division, Department of Internal Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA.; Shroff GR; Cardiology Division, Department of Internal Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA.; Sidhu MS; Division of Cardiology, Department of Medicine, Albany Medical College, Albany, New York, USA.; Bangalore S; Division of Cardiology, New York University Grossman School of Medicine, New York City, New York, USA.
Source
Publisher: Wiley-Liss Country of Publication: United States NLM ID: 100884139 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1522-726X (Electronic) Linking ISSN: 15221946 NLM ISO Abbreviation: Catheter Cardiovasc Interv Subsets: MEDLINE
Subject
Language
English
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.
(© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)
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.
(© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)