Abstract：
OBJECTIVE: To determine whether coronary computed tomography angiography (CCTA) can improve the diagnostic work-up of patients with acute chest pain and inconclusively high-sensitivity troponins (hs-troponin).
METHODS: We conducted a prospective, blinded, observational, multicentre study. Patients aged 30-80 years presenting to the emergency department with acute chest pain and inconclusively elevated hs-troponins were included and underwent CCTA. The primary outcome was the diagnostic accuracy of ≥ 50% stenosis on CCTA to identify patients with type-1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
RESULTS: A total of 106 patients (mean age 65 ± 10, 29% women) were enrolled of whom 20 patients (19%) had an adjudicated diagnosis of type-1 NSTE-ACS. In 45 patients, CCTA revealed non-obstructive coronary artery disease (CAD) or no CAD. Sensitivity, specificity, negative predictive value (NPV), positive predictive value and area-under-the-curve (AUC) of ≥ 50% stenosis on CCTA to identify patients with type 1 NSTE-ACS, was 95% (95% confidence interval: 74-100), 56% (45-68), 98% (87-100), 35% (29-41) and 0.83 (0.73-0.94), respectively. When only coronary segments with a diameter ≥ 2 mm were considered for the adjudication of type 1 NSTE-ACS, the sensitivity and NPV increased to 100%. In 8 patients, CCTA enabled the detection of clinically relevant non-coronary findings.
CONCLUSIONS: The absence of ≥ 50% coronary artery stenosis on CCTA can be used to rule out type 1 NSTE-ACS in acute chest pain patients with inconclusively elevated hs-troponins. Additionally, CCTA can help improve the diagnostic work-up by detecting other relevant conditions that cause acute chest pain and inconclusively elevated hs-troponins.
CONCLUSIONS: Coronary CTA (CCTA) can safely rule out type 1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients presenting to the ED with acute chest pain and inconclusively elevated hs-troponins, while also detecting other relevant non-coronary conditions.
BACKGROUND: Clinicaltrials.gov (NCT03129659). Registered on 26 April 2017 KEY POINTS: Acute chest discomfort is a common presenting complaint in the emergency department. CCTA achieved very high negative predictive values for type 1 NSTE-ACS in this population. CCTA can serve as an adjunct for evaluating equivocal ACS and evaluates for other pathology.
METHODS: We conducted a prospective, blinded, observational, multicentre study. Patients aged 30-80 years presenting to the emergency department with acute chest pain and inconclusively elevated hs-troponins were included and underwent CCTA. The primary outcome was the diagnostic accuracy of ≥ 50% stenosis on CCTA to identify patients with type-1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
RESULTS: A total of 106 patients (mean age 65 ± 10, 29% women) were enrolled of whom 20 patients (19%) had an adjudicated diagnosis of type-1 NSTE-ACS. In 45 patients, CCTA revealed non-obstructive coronary artery disease (CAD) or no CAD. Sensitivity, specificity, negative predictive value (NPV), positive predictive value and area-under-the-curve (AUC) of ≥ 50% stenosis on CCTA to identify patients with type 1 NSTE-ACS, was 95% (95% confidence interval: 74-100), 56% (45-68), 98% (87-100), 35% (29-41) and 0.83 (0.73-0.94), respectively. When only coronary segments with a diameter ≥ 2 mm were considered for the adjudication of type 1 NSTE-ACS, the sensitivity and NPV increased to 100%. In 8 patients, CCTA enabled the detection of clinically relevant non-coronary findings.
CONCLUSIONS: The absence of ≥ 50% coronary artery stenosis on CCTA can be used to rule out type 1 NSTE-ACS in acute chest pain patients with inconclusively elevated hs-troponins. Additionally, CCTA can help improve the diagnostic work-up by detecting other relevant conditions that cause acute chest pain and inconclusively elevated hs-troponins.
CONCLUSIONS: Coronary CTA (CCTA) can safely rule out type 1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients presenting to the ED with acute chest pain and inconclusively elevated hs-troponins, while also detecting other relevant non-coronary conditions.
BACKGROUND: Clinicaltrials.gov (NCT03129659). Registered on 26 April 2017 KEY POINTS: Acute chest discomfort is a common presenting complaint in the emergency department. CCTA achieved very high negative predictive values for type 1 NSTE-ACS in this population. CCTA can serve as an adjunct for evaluating equivocal ACS and evaluates for other pathology.
摘要：
目的：确定冠状动脉计算机断层扫描血管造影（CCTA）是否可以改善急性胸痛和不确定的高敏肌钙蛋白（hs-肌钙蛋白）患者的诊断检查。
方法：我们进行了前瞻性，失明,观察,多中心研究。纳入了30-80岁到急诊科就诊的急性胸痛和hs-肌钙蛋白升高的患者，并接受了CCTA。主要结果是CCTA狭窄≥50％的诊断准确性，以识别1型非ST段抬高急性冠状动脉综合征（NSTE-ACS）患者。
结果：共纳入106例患者（平均年龄65±10岁，29%为女性），其中20例（19%）确诊为1型NSTE-ACS。在45名患者中，CCTA显示非阻塞性冠状动脉疾病（CAD）或无CAD。灵敏度,特异性，负预测值(NPV)，CCTA上≥50%狭窄的阳性预测值和曲线下面积（AUC），以识别1型NSTE-ACS患者，为95%(95%置信区间：74-100)，56%（45-68），98%（87-100），35%(29-41)和0.83(0.73-0.94)，分别。当仅考虑直径≥2mm的冠状动脉节段进行1型NSTE-ACS的裁定时，灵敏度和净现值增加到100%。在8名患者中，CCTA能够检测临床相关的非冠状动脉发现。
结论：CCTA没有≥50%的冠状动脉狭窄可用于排除hs-肌钙蛋白不确定升高的急性胸痛患者的1型NSTE-ACS。此外,CCTA可以通过检测引起急性胸痛和不确定的hs-肌钙蛋白升高的其他相关疾病来帮助改善诊断工作。
结论：冠状动脉CTA（CCTA）可以安全地排除1型非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者出现急性胸痛和高质肌钙蛋白升高，同时还检测其他相关的非冠状动脉状况。
背景：Clinicaltrials.gov（NCT03129659）。2017年4月26日登记要点：急性胸部不适是急诊科常见的投诉。在该人群中，CCTA对1型NSTE-ACS的阴性预测值非常高。CCTA可以作为评估模棱两可的ACS和评估其他病理的辅助手段。
方法：我们进行了前瞻性，失明,观察,多中心研究。纳入了30-80岁到急诊科就诊的急性胸痛和hs-肌钙蛋白升高的患者，并接受了CCTA。主要结果是CCTA狭窄≥50％的诊断准确性，以识别1型非ST段抬高急性冠状动脉综合征（NSTE-ACS）患者。
结果：共纳入106例患者（平均年龄65±10岁，29%为女性），其中20例（19%）确诊为1型NSTE-ACS。在45名患者中，CCTA显示非阻塞性冠状动脉疾病（CAD）或无CAD。灵敏度,特异性，负预测值(NPV)，CCTA上≥50%狭窄的阳性预测值和曲线下面积（AUC），以识别1型NSTE-ACS患者，为95%(95%置信区间：74-100)，56%（45-68），98%（87-100），35%(29-41)和0.83(0.73-0.94)，分别。当仅考虑直径≥2mm的冠状动脉节段进行1型NSTE-ACS的裁定时，灵敏度和净现值增加到100%。在8名患者中，CCTA能够检测临床相关的非冠状动脉发现。
结论：CCTA没有≥50%的冠状动脉狭窄可用于排除hs-肌钙蛋白不确定升高的急性胸痛患者的1型NSTE-ACS。此外,CCTA可以通过检测引起急性胸痛和不确定的hs-肌钙蛋白升高的其他相关疾病来帮助改善诊断工作。
结论：冠状动脉CTA（CCTA）可以安全地排除1型非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者出现急性胸痛和高质肌钙蛋白升高，同时还检测其他相关的非冠状动脉状况。
背景：Clinicaltrials.gov（NCT03129659）。2017年4月26日登记要点：急性胸部不适是急诊科常见的投诉。在该人群中，CCTA对1型NSTE-ACS的阴性预测值非常高。CCTA可以作为评估模棱两可的ACS和评估其他病理的辅助手段。
