Key result
Delaying coronary artery bypass grafting in stable NSTEMI patients until cardiac troponin T levels fall below 1 ng/ml resulted in 0% hospital mortality and 94% mid-term survival, comparable to elective surgery in troponin-negative patients.
Why the study?
Does delaying CABG until cTnT levels drop below 1 ng/ml result in safe postoperative outcomes in stable NSTEMI patients?
Cohort (n=200)
Random selection of control group from eligible pool
No
Does delaying CABG until cTnT levels drop below 1 ng/ml result in safe postoperative outcomes in stable NSTEMI patients?
Delaying CABG until cTnT levels drop below 1 ng/ml in stable NSTEMI patients is safe and yields mid-term survival comparable to elective CABG in cTnT negative patients.
Answers are grounded in this paper and cite their sources.
May support troponin-guided CABG timing in stable NSTEMI; hypothesis-generating and requires RCTs before practice change.
INTRODUCTION: The aim of the study was to assess whether a cardiac troponin T (cTnT) level 1 ng/ml or below threshold is safe and to evaluate mid-term follow-up results in stable patients with non-ST-segment elevation after acute myocardial infarction. MATERIAL AND METHODS: Among cTnT positive patients who presented to the emergency unit with chest pain and received coronary angiography, 100 patients who underwent isolated coronary artery bypass grafting (CABG) constituted the study group (group 1). The same number of patients (n = 100) who were cTnT negative and underwent an isolated CABG operation under elective conditions were selected as the control group (group 2). RESULTS: Among preoperative criteria, group 1 had significantly higher smoking rates (74% vs. 41%, p = 0.0001), and significantly lower ejection fraction values (47.1 ±8.25, 54.69 ±8.73, p = 0.0001). There were no significant differences between the groups with respect to operative parameters. Postoperative follow-up periods were significantly longer in group 1 (23.25 ±14 vs. 17.55 ±7.95 months, p = 0.001). Average waiting time for cTnT to drop below the 1 ng/ml threshold value was 5.73 ±2.95 (1-12) days. Intra-aortic balloon pump use in Groups 1 and 2 was 3% and 1%, respectively. There were no hospital mortalities in either group. Mortality rates at mid term were 6% in both groups. CONCLUSIONS: This study compared two groups positive and negative for preoperative cTnT. The findings show that it is safe to wait until cTnT levels decrease to the 1 ng/ml threshold value in cTnT positive patients having a stable course. This waiting period is not very long, which is significant with respect to potential complications.
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Özbek et al. (2014) conducted a cohort in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=200). Preoperative cTnT positive NSTEMI with delayed CABG (until cTnT ≤ 1 ng/ml) vs. Preoperative cTnT negative elective CABG was evaluated on Mid-term survival (p=0.395). Delaying coronary artery bypass grafting in stable NSTEMI patients until cardiac troponin T levels fall below 1 ng/ml resulted in 0% hospital mortality and 94% mid-term survival, comparable to elective surgery in troponin-negative patients.
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