Troponin-Guided Coronary Computed Tomography 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 journalArticlepeer-review

Abstract / Description of output

Background: Patients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events. Objective: We evaluated the utility of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation after myocardial infarction has been excluded. Methods: We performed 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 centile. 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% (156/250) had coronary artery disease (CAD). Patients with intermediate hs-cTnI concentrations (between 5 ng/L and the sex-specific 99th centile) were more likely to have CAD than those with hs-cTnI concentrations <5 ng/L (71.9% [120/167] versus 43.4% [36/83]; odds ratio 3.33 [95% confidence interval 1.92-5.78]). Conversely, there was no association between anginal symptoms and CAD (63.2% [67/106] versus 61.8% [89/144]; odds ratio 0.92 [0.48-1.76]). Most patients with CAD did not have a prior diagnosis (53.2%, 83/156) and were not on antiplatelet and statin therapies (63.5%, 99/156) prior to undergoing CCTA. Conclusions: In patients who had myocardial infarction excluded, CAD was three-times more likely in those with intermediate 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 languageEnglish
JournalJournal of the American College of Cardiology
Publication statusPublished - 5 Oct 2021


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