Diagnostic Yield of Emergent Coronary CT Angiography in Intermediate-to-high-risk Patients for Suspected Acute Coronary Syndrome: Results from an Emergency Department Registry

Zielsetzung:

Coronary computed tomography angiography (CTA) is an established diagnostic strategy for patients presenting with low-to-intermediate-risk for acute coronary syndrome (ACS) to emergency departments. Our aim was to evaluate the utility of CTA in higher-risk patients, a population less studied in randomized trials.

Material und Methoden:

We included patients with suspicion of ACS referred to coronary CTA between 10/2012 and 02/2017 who had ECG abnormalities (ST-segment depression > 0.5 mm, T-wave inversion > 1 mm, and non-specific ST/T-wave changes), history of coronary artery disease (CAD), or elevated Troponin T (TnT) concentration (< 0.03 ng/mL). Primary endpoint was incidence of ACS and prevalence of obstructive CAD (obsCAD) (CAD-RADS 3 and above). Secondary endpoints included downstream testing and revascularization during index hospitalization, and major adverse cardiovascular events (MACE) within 30 days after discharge from index hospitalization.

Ergebnisse:

Overall, 124/2,290 (5.4%) patients met inclusion criteria (56.3 ± 11.1 years, 60.5% male) of whom 42 (33.9%) had ECG changes, 80 (64.5%) who had known CAD and 18 (14.5%) whose TnT was elevated. Coronary CTA detected obsCAD in 50 (40.3%) patients and ruled it out in 74 (59.7%). 15 (12.1%) patients with obsCAD needed revascularization. Overall, 36 (29.0%) patients had ACS (myocardial infarct, n = 15, 41.2%; unstable angina, n = 21, 58.3%), among them 34 (68.0%) with obsCAD and 2 without obsCAD but elevated TnT (type II myocardial infarct). MACE occurred in 2 (1.6%) obsCAD patients.

Schlussfolgerungen:

Coronary CTA could exclude obsCAD in the majority of intermediate-to-high-risk patients for ACS, potentially avoiding unnecessary invasive coronary angiography.

No conflict of interest has been declared by the author(s).