{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:08:01Z","timestamp":1740146881581,"version":"3.37.3"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T00:00:00Z","timestamp":1686787200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016545","name":"Roche Diagnostics","doi-asserted-by":"publisher","award":["Unrestricted grant"],"award-info":[{"award-number":["Unrestricted grant"]}],"id":[{"id":"10.13039\/100016545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1124471"],"award-info":[{"award-number":["APP1124471"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["APP1024008"],"award-info":[{"award-number":["APP1024008"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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 \u2018non-elevated\u2019 (NE). Hs-cTnT greater than upper reference limit (14ng\/L) were classified as \u2018elevated hs-cTnT with dynamic change\u2019 (encompassing acute myocardial injury, Type 1 MI, and Type 2 MI), or \u2018non-dynamic hs-cTnT elevation\u2019 (chronic myocardial injury). Patients with hs-cTnT &lt;5ng\/L and\/or eGFR&lt;15mmol\/L\/1.73m<jats:sup>2<\/jats:sup> were excluded. ICA was performed within 30 days of admission. Primary outcome was defined as composite endpoint of death, MI, or unstable angina at 12 months.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Altogether, 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\u20135.82; p&lt;0.001 Non-dynamic: HR: 2.39 95% confidence interval [CI]:1.74\u20133.28, p&lt;0.001). Hs-cTnT thresholds where benefit from initial ICA strategy appeared to emerge was observed at 110ng\/L and 50ng\/L in dynamic and non-dynamic elevations, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Early 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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0286157","type":"journal-article","created":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T17:59:12Z","timestamp":1686851952000},"page":"e0286157","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Contrasting the potential benefits of early invasive coronary angiography in acute and chronic myocardial injury 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