Cargando…
Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction
BACKGROUND: Patients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events. OBJECTIVES: This study evaluated the usefulness of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation afte...
Autores principales: | , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Biomedical
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482793/ https://www.ncbi.nlm.nih.gov/pubmed/34593122 http://dx.doi.org/10.1016/j.jacc.2021.07.055 |
_version_ | 1784576983815946240 |
---|---|
author | Lee, Kuan Ken Bularga, Anda O’Brien, Rachel Ferry, Amy V. Doudesis, Dimitrios Fujisawa, Takeshi Kelly, Shauna Stewart, Stacey Wereski, Ryan Cranley, Denise van Beek, Edwin J.R. Lowe, David J. Newby, David E. Williams, Michelle C. Gray, Alasdair J. Mills, Nicholas L. |
author_facet | Lee, Kuan Ken Bularga, Anda O’Brien, Rachel Ferry, Amy V. Doudesis, Dimitrios Fujisawa, Takeshi Kelly, Shauna Stewart, Stacey Wereski, Ryan Cranley, Denise van Beek, Edwin J.R. Lowe, David J. Newby, David E. Williams, Michelle C. Gray, Alasdair J. Mills, Nicholas L. |
author_sort | Lee, Kuan Ken |
collection | PubMed |
description | BACKGROUND: Patients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events. OBJECTIVES: This study evaluated the usefulness of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation after myocardial infarction has been excluded. METHODS: This is a prospective cohort study of patients presenting to the emergency department with suspected acute coronary syndrome and hs-cTnI concentrations below the sex-specific 99th percentile. Patients were recruited in a 2:1 fashion, stratified by peak hs-cTnI concentration above and below the risk stratification threshold of 5 ng/L. All patients underwent coronary computed tomography angiography (CCTA) after hospital discharge. RESULTS: Overall, 250 patients were recruited (61.4 ± 12.2 years 31% women) in whom 62.4% (156 of 250 patients) had coronary artery disease (CAD). Patients with intermediate hs-cTnI concentrations (between 5 ng/L and the sex-specific 99th percentile) were more likely to have CAD than those with hs-cTnI concentrations <5 ng/L (71.9% [120 of 167 patients] vs 43.4% [36 of 83 patients]; odds ratio: 3.33; 95% CI: 1.92-5.78). Conversely, there was no association between anginal symptoms and CAD (63.2% [67 of 106 patients] vs 61.8% [89 of 144 patients]; odds ratio: 0.92; 95% CI: 0.48-1.76). Most patients with CAD did not have a previous diagnosis (53.2%; 83 of 156 patients) and were not on antiplatelet and statin therapies (63.5%; 99 of 156 patients) before they underwent CCTA. CONCLUSIONS: In patients who had myocardial infarction excluded, CAD was 3× more likely in those with intermediate hs-cTnI concentrations compared with low hs-cTnI concentrations. In such patients, CCTA could help to identify those with occult CAD and to target preventative treatments, thereby improving clinical outcomes. |
format | Online Article Text |
id | pubmed-8482793 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier Biomedical |
record_format | MEDLINE/PubMed |
spelling | pubmed-84827932021-10-06 Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction Lee, Kuan Ken Bularga, Anda O’Brien, Rachel Ferry, Amy V. Doudesis, Dimitrios Fujisawa, Takeshi Kelly, Shauna Stewart, Stacey Wereski, Ryan Cranley, Denise van Beek, Edwin J.R. Lowe, David J. Newby, David E. Williams, Michelle C. Gray, Alasdair J. Mills, Nicholas L. J Am Coll Cardiol Original Investigation BACKGROUND: Patients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events. OBJECTIVES: This study evaluated the usefulness of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation after myocardial infarction has been excluded. METHODS: This is a prospective cohort study of patients presenting to the emergency department with suspected acute coronary syndrome and hs-cTnI concentrations below the sex-specific 99th percentile. Patients were recruited in a 2:1 fashion, stratified by peak hs-cTnI concentration above and below the risk stratification threshold of 5 ng/L. All patients underwent coronary computed tomography angiography (CCTA) after hospital discharge. RESULTS: Overall, 250 patients were recruited (61.4 ± 12.2 years 31% women) in whom 62.4% (156 of 250 patients) had coronary artery disease (CAD). Patients with intermediate hs-cTnI concentrations (between 5 ng/L and the sex-specific 99th percentile) were more likely to have CAD than those with hs-cTnI concentrations <5 ng/L (71.9% [120 of 167 patients] vs 43.4% [36 of 83 patients]; odds ratio: 3.33; 95% CI: 1.92-5.78). Conversely, there was no association between anginal symptoms and CAD (63.2% [67 of 106 patients] vs 61.8% [89 of 144 patients]; odds ratio: 0.92; 95% CI: 0.48-1.76). Most patients with CAD did not have a previous diagnosis (53.2%; 83 of 156 patients) and were not on antiplatelet and statin therapies (63.5%; 99 of 156 patients) before they underwent CCTA. CONCLUSIONS: In patients who had myocardial infarction excluded, CAD was 3× more likely in those with intermediate hs-cTnI concentrations compared with low hs-cTnI concentrations. In such patients, CCTA could help to identify those with occult CAD and to target preventative treatments, thereby improving clinical outcomes. Elsevier Biomedical 2021-10-05 /pmc/articles/PMC8482793/ /pubmed/34593122 http://dx.doi.org/10.1016/j.jacc.2021.07.055 Text en © 2021 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Original Investigation Lee, Kuan Ken Bularga, Anda O’Brien, Rachel Ferry, Amy V. Doudesis, Dimitrios Fujisawa, Takeshi Kelly, Shauna Stewart, Stacey Wereski, Ryan Cranley, Denise van Beek, Edwin J.R. Lowe, David J. Newby, David E. Williams, Michelle C. Gray, Alasdair J. Mills, Nicholas L. Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction |
title | Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction |
title_full | Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction |
title_fullStr | Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction |
title_full_unstemmed | Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction |
title_short | Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction |
title_sort | troponin-guided coronary computed tomographic angiography after exclusion of myocardial infarction |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482793/ https://www.ncbi.nlm.nih.gov/pubmed/34593122 http://dx.doi.org/10.1016/j.jacc.2021.07.055 |
work_keys_str_mv | AT leekuanken troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT bulargaanda troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT obrienrachel troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT ferryamyv troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT doudesisdimitrios troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT fujisawatakeshi troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT kellyshauna troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT stewartstacey troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT wereskiryan troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT cranleydenise troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT vanbeekedwinjr troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT lowedavidj troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT newbydavide troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT williamsmichellec troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT grayalasdairj troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction AT millsnicholasl troponinguidedcoronarycomputedtomographicangiographyafterexclusionofmyocardialinfarction |