Maladies cardiovasculaires et diagnostic

Computed Tomography Coronary Angiography Added to Standard Care with High-Sensitivity Cardiac Troponin for Acute Chest Pain

Abstract

Jae Gyung Kim, Eun Ho Choo, Dongjae Lee, Chan JK, Hyo SA, Jong Min Lee and Hui-Kyoung J

European Society of Cardiology (ESC) 0/3-h algorithm using high sensitivity cardiac troponin (hs-troponin) is recommended to detect acute myocardial infarction (MI) for patients with acute chest pain. As hs-troponin may be less specific, we assessed the usefulness of coronary computed tomography angiography (CCTA) in addition to standard care for patients with acute chest pain. We investigated 695 patients who visited the emergency department for acute chest pain and performed serial hs-troponin T and CCTA. Obstructive coronary artery disease (CAD) on CCTA was defined as >=50% stenosis. The primary outcome was the occurrence of MI within 30 days. According to ESC 0/3-h algorithm, patients were categorized into rule-out (425, 61.2%), rule-in (155, 22.3%), and observe group (115, 16.5%). Eighty-one patients (11.7%) were diagnosed with MI. Two hundred ten patients had obstructive CAD on CCTA. The addition of obstructive CAD on CCTA to ESC 0/3-h algorithm improved the diagnostic accuracy for MI (area under the curve: from 0.85 to 0.911, p=0.003). Even for the rule-in and rule-out patients, the specificity (from 78.9% to 94.5%) and positive predictive value (from 32.1% to 62.8%) were significantly improved after the addition of CCTA to ESC 0/3-h algorithm. Half of the patients in the rule-in group did not undergo invasive coronary angiography based on CCTA findings without further MI events. CCTA added to the serial hs-troponin may improve the prediction of MI in patients with acute chest pain.