Coronary computed tomography angiography improves assessment of patients with acute chest pain and inconclusively elevated high-sensitivity troponins

Murat Arslan*, Jeroen Schaap, Bart van Gorsel, Anton Aubanell, Ricardo P. J. Budde, Alexander Hirsch, Martijn W. Smulders, Casper Mihl, Peter Damman, Olga Sliwicka, Jesse Habets, Eric A. Dubois, Admir Dedic

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

ObjectivesTo determine whether coronary computed tomography angiography (CCTA) can improve the diagnostic work-up of patients with acute chest pain and inconclusively high-sensitivity troponins (hs-troponin).MethodsWe conducted a prospective, blinded, observational, multicentre study. Patients aged 30-80 years presenting to the emergency department with acute chest pain and inconclusively elevated hs-troponins were included and underwent CCTA. The primary outcome was the diagnostic accuracy of >= 50% stenosis on CCTA to identify patients with type-1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS).ResultsA total of 106 patients (mean age 65 +/- 10, 29% women) were enrolled of whom 20 patients (19%) had an adjudicated diagnosis of type-1 NSTE-ACS. In 45 patients, CCTA revealed non-obstructive coronary artery disease (CAD) or no CAD. Sensitivity, specificity, negative predictive value (NPV), positive predictive value and area-under-the-curve (AUC) of >= 50% stenosis on CCTA to identify patients with type 1 NSTE-ACS, was 95% (95% confidence interval: 74-100), 56% (45-68), 98% (87-100), 35% (29-41) and 0.83 (0.73-0.94), respectively. When only coronary segments with a diameter >= 2 mm were considered for the adjudication of type 1 NSTE-ACS, the sensitivity and NPV increased to 100%. In 8 patients, CCTA enabled the detection of clinically relevant non-coronary findings.ConclusionThe absence of >= 50% coronary artery stenosis on CCTA can be used to rule out type 1 NSTE-ACS in acute chest pain patients with inconclusively elevated hs-troponins. Additionally, CCTA can help improve the diagnostic work-up by detecting other relevant conditions that cause acute chest pain and inconclusively elevated hs-troponins.Clinical relevance statementCoronary CTA (CCTA) can safely rule out type 1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients presenting to the ED with acute chest pain and inconclusively elevated hs-troponins, while also detecting other relevant non-coronary conditions.Trial registrationClinicaltrials.gov (NCT03129659). Registered on 26 April 2017
Original languageEnglish
Number of pages9
JournalEuropean Radiology
DOIs
Publication statusE-pub ahead of print - 1 Aug 2024

Keywords

  • Computed tomography angiography
  • Troponin
  • Non-ST elevated myocardial infarction
  • Acute coronary syndrome
  • CT ANGIOGRAPHY
  • MYOCARDIAL-INFARCTION
  • DIAGNOSIS
  • ALGORITHM
  • TRIAGE
  • RULE
  • CARE

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