JACC-CARDIOVASCULAR IMAGING | 卷:8 |
hs-Troponin I Followed by CT Angiography Improves Acute Coronary Syndrome Risk Stratification Accuracy and Work-Up in Acute Chest Pain Patients Results From ROMICAT II Trial | |
Article | |
Ferencik, Maros1,2,3,4  Liu, Ting2,3,4,5  Mayrhofer, Thomas2,3,4  Puchner, Stefan B.2,3,4,6  Lu, Michael T.2,3,4  Maurovich-Horvat, Pal7  Pope, J. Hector8  Truong, Quynh A.2,3,4,9,10  Udelson, James E.11,12  Peacock, W. Frank13  White, Charles S.14  Woodard, Pamela K.15  Fleg, Jerome L.16  Nagurney, John T.3,17  Januzzi, James L.3,18  Hoffmann, Udo2,3,4,18  | |
[1] Oregon Hlth & Sci Univ, Knight Cardiovasc Inst, Portland, OR 97239 USA | |
[2] Massachusetts Gen Hosp, Dept Radiol, Boston, MA 02114 USA | |
[3] Harvard Univ, Sch Med, Boston, MA USA | |
[4] Massachusetts Gen Hosp, Cardiac MR PET CT Program, Boston, MA 02114 USA | |
[5] China Med Univ, Dept Radiol, Affiliated Hosp 1, Shenyang 110001, Peoples R China | |
[6] Med Univ Vienna, Dept Biomed Imaging & Image Guided Therapy, Vienna, Austria | |
[7] Semmelweis Univ, Heart & Vasc Ctr, TA SE Lendulet Cardiovasc Imaging Res Grp, H-1085 Budapest, Hungary | |
[8] Baystate Med Ctr, Dept Emergency Med, Springfield, MA USA | |
[9] New York Presbyterian Hosp, Dalio Inst Cardiovasc Imaging, New York, NY USA | |
[10] Weill Cornell Med Coll, New York, NY USA | |
[11] Tufts Med Ctr, Div Cardiol, Boston, MA USA | |
[12] Tufts Med Ctr, Ctr Cardiovasc, Boston, MA USA | |
[13] Baylor Coll Med, Dept Emergency Med, Houston, TX 77030 USA | |
[14] Univ Maryland, Sch Med, Baltimore, MD 21201 USA | |
[15] Washington Univ, Sch Med, Mallinckrodt Inst Radiol, St Louis, MO USA | |
[16] NHLBI, Div Cardiovasc Sci, Bethesda, MD 20892 USA | |
[17] Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA 02114 USA | |
[18] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA | |
关键词: acute coronary syndrome; coronary computed tomography angiography; coronary plaque; emergency department; highly sensitive troponin; risk stratification; | |
DOI : 10.1016/j.jcmg.2015.06.016 | |
来源: Elsevier | |
【 摘 要 】
OBJECTIVES This study compared diagnostic accuracy of conventional troponin/traditional coronary artery disease (CAD) assessment and highly sensitive troponin (hsTn) I/advanced CAD assessment for acute coronary syndrome (ACS) during the index hospitalization. BACKGROUND hsTnI and advanced assessment of CAD using coronary computed tomography angiography (CTA) are promising candidates to improve the accuracy of emergency department evaluation of patients with suspected ACS. METHODS We performed an observational cohort study in patients with suspected ACS enrolled in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia using Computer Assisted Tomography) trial and randomized to coronary CTA who also had hsTnI measurement at the time of the emergency department presentation. We assessed coronary CTA for traditional (no CAD, nonobstructive CAD, >= 50% stenosis) and advanced features of CAD (>= 50% stenosis, high-risk plaque features: positive remodeling, low <30-Hounsfield units plaque, napkin-ring sign, spotty calcium). RESULTS Of 160 patients (mean age: 53 +/- 8 years, 40% women) 10.6% were diagnosed with ACS. The ACS rate in patients with hsTnI below the limit of detection (n = 9, 5.6%), intermediate (n = 139, 86.9%), and above the 99th percentile (n = 12, 7.5%) was 0%, 8.6%, and 58.3%, respectively. Absence of >= 50% stenosis and high-risk plaque ruled out ACS in patients with intermediate hsTnI (n = 87, 54.4%; ACS rate 0%), whereas patients with both >= 50% stenosis and high-risk plaque were at high risk (n = 13, 8.1%; ACS rate 69.2%) and patients with either >= 50% stenosis or high-risk plaque were at intermediate risk for ACS (n = 39, 24.4%; ACS rate 7.7%). hsTnI/advanced coronary CTA assessment significantly improved the diagnostic accuracy for ACS as compared to conventional troponin/traditional coronary CTA (area under the curve 0.84, 95% confidence interval [CI]: 0.80 to .88 vs. 0.74, 95% CI: 0.70 to 0.78; p < 0.001). CONCLUSIONS hsTnI at the time of presentation followed by early advanced coronary CTA assessment improves the risk stratification and diagnostic accuracy for ACS as compared to conventional troponin and traditional coronary CTA assessment. (C) 2015 by the American College of Cardiology Foundation.
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