Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction.

Kuan Ken Lee; Anda Bularga; Rachel O'Brien; Amy V. Ferry; Dimitrios Doudesis; Takeshi Fujisawa; Shauna Kelly; Stacey Stewart; Ryan Wereski; Denise Cranley; Edwin J.R. van Beek; David J. Lowe; David E. Newby; Michelle C. Williams; Alasdair J. Gray; Nicholas L. Mills

doi:10.1016/j.jacc.2021.07.055

Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction.

Kuan Ken Lee, Anda Bularga, Rachel O'Brien, Amy V. Ferry, Dimitrios Doudesis, Takeshi Fujisawa, Shauna Kelly, Stacey Stewart, Ryan Wereski, Denise Cranley, Edwin J.R. van Beek, David J. Lowe, David E. Newby, Michelle C. Williams, Alasdair J. Gray, Nicholas L. Mills

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Pages (from-to)	1407–1417
Journal	Journal of the American College of Cardiology
Volume	78
Issue number	14
Early online date	27 Sept 2021
DOIs	https://doi.org/10.1016/j.jacc.2021.07.055
Publication status	Published - Oct 2021

Keywords / Materials (for Non-textual outputs)

acute coronary syndrome
coronary computed tomography angiogram
troponin

Access to Document

10.1016/j.jacc.2021.07.055Licence: Creative Commons: Attribution (CC-BY)

lee-et-al-troponin-guided-coronary-computed-tomographic-angiography-after-exclusion-of-myocardial-infarctionFinal published version, 865 KBLicence: Creative Commons: Attribution (CC-BY)

Cite this

Lee, K. K., Bularga, A., O'Brien, R., Ferry, A. V., Doudesis, D., Fujisawa, T., Kelly, S., Stewart, S., Wereski, R., Cranley, D., van Beek, E. J. R., Lowe, D. J., Newby, D. E., Williams, M. C., Gray, A. J., & Mills, N. L. (2021). Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction. Journal of the American College of Cardiology, 78(14), 1407–1417. https://doi.org/10.1016/j.jacc.2021.07.055

@article{9cf1665068954f5fb02c90aadf64be94,

title = "Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction.",

abstract = "BackgroundPatients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events.ObjectivesThis study evaluated the usefulness of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation after myocardial infarction has been excluded.MethodsThis 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.ResultsOverall, 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.ConclusionsIn 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.",

keywords = "acute coronary syndrome, coronary computed tomography angiogram, troponin",

author = "Lee, {Kuan Ken} and Anda Bularga and Rachel O'Brien and Ferry, {Amy V.} and Dimitrios Doudesis and Takeshi Fujisawa and Shauna Kelly and Stacey Stewart and Ryan Wereski and Denise Cranley and {van Beek}, {Edwin J.R.} and Lowe, {David J.} and Newby, {David E.} and Williams, {Michelle C.} and Gray, {Alasdair J.} and Mills, {Nicholas L.}",

year = "2021",

month = oct,

doi = "10.1016/j.jacc.2021.07.055",

language = "English",

volume = "78",

pages = "1407–1417",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "14",

}

Lee, KK, Bularga, A, O'Brien, R, Ferry, AV, Doudesis, D , Fujisawa, T, Kelly, S, Stewart, S, Wereski, R, Cranley, D , van Beek, EJR, Lowe, DJ, Newby, DE , Williams, MC , Gray, AJ & Mills, NL 2021, 'Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction.', Journal of the American College of Cardiology, vol. 78, no. 14, pp. 1407–1417. https://doi.org/10.1016/j.jacc.2021.07.055

TY - JOUR

T1 - Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction.

AU - Lee, Kuan Ken

AU - Bularga, Anda

AU - O'Brien, Rachel

AU - Ferry, Amy V.

AU - Doudesis, Dimitrios

AU - Fujisawa, Takeshi

AU - Kelly, Shauna

AU - Stewart, Stacey

AU - Wereski, Ryan

AU - Cranley, Denise

AU - van Beek, Edwin J.R.

AU - Lowe, David J.

AU - Newby, David E.

AU - Williams, Michelle C.

AU - Gray, Alasdair J.

AU - Mills, Nicholas L.

PY - 2021/10

Y1 - 2021/10

N2 - BackgroundPatients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events.ObjectivesThis study evaluated the usefulness of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation after myocardial infarction has been excluded.MethodsThis 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.ResultsOverall, 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.ConclusionsIn 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.

AB - BackgroundPatients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events.ObjectivesThis study evaluated the usefulness of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation after myocardial infarction has been excluded.MethodsThis 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.ResultsOverall, 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.ConclusionsIn 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.

KW - acute coronary syndrome

KW - coronary computed tomography angiogram

KW - troponin

UR - http://europepmc.org/abstract/med/34593122

U2 - 10.1016/j.jacc.2021.07.055

DO - 10.1016/j.jacc.2021.07.055

M3 - Article

C2 - 34593122

SN - 0735-1097

VL - 78

SP - 1407

EP - 1417

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 14

ER -

Troponin-Guided Coronary Computed Tomographic Angiography After Exclusion of Myocardial Infarction.

Abstract

Keywords / Materials (for Non-textual outputs)

Access to Document

Other files and links

Fingerprint

Cite this