Abstract 13387: Highly Sensitive Troponin I and Coronary Computed Tomography Angiography Assessment of Stenosis and High-risk Plaque Permit Rapid Classification of Acute Coronary Syndrome Risk in Chest Pain Patients: Results from the ROMICAT II Trial
| Autor: | Michael T. Lu, James L. Januzzi, Udo Hoffmann, Pál Maurovich-Horvat, Stefan Puchner, J. Hector Pope, W. Frank Peacock, Charles S. White, Ting Liu, Jerome L. Fleg, John T. Nagurney, Thomas Mayrhofer, Quynh A. Truong, Maros Ferencik, Pamela K. Woodard, James E. Udelson |
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| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome biology business.industry Emergency department Chest pain medicine.disease Triage Troponin Coronary artery disease Stenosis Physiology (medical) Troponin I medicine biology.protein Radiology medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 130 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circ.130.suppl_2.13387 |
| Popis: | Introduction: Highly sensitive troponin (hsTn) and coronary computed tomography angiography (CCTA) are promising diagnostic tools for triage of acute chest pain patients in the emergency department (ED). We determined whether a diagnostic strategy of initial hsTn I followed by early CCTA improves classification of ACS risk. Methods: We included ED patients with acute chest pain, negative electrocardiogram and conventional troponin who were enrolled in the ROMICAT II trial, randomized to CCTA and had hsTn I (hsVista, Siemens Diagnostics) measured at the time of presentation. The patients were categorized as having hsTn I < the limit of detection ( 99th percentile (>49 pg/mL), or intermediate. Core lab readers assessed CCTA for the presence of ≥50% stenosis and high-risk plaque features (positive remodeling, low CT attenuation Results: Overall, 160 patients met inclusion criteria (mean age 53±8 years, 40% women, ACS during index hospitalization 10.6%, n=19). The ACS rate was 0% (n=0/9) for patients with HsTn I < the limit of detection 8.6% (n=12/139) for patients with intermediate HsTn I and 53.8% (n=7/12) for patients with hsTnI > 99th percentile. No coronary plaque was present in 68 (42.5%), non-obstructive CAD in 70 (43.8%), ≥50% stenosis in 22 (13.8%), and high-risk plaque in 61 (38.1%) patients. The figure shows ACS risk stratification based on hsTn I followed by CCTA. The addition of CCTA increased the number of patients categorized as low risk from 9 to 96 and high risk from 12 to 25 and re-classified 63% of patients (n=100). The net gain in reclassification proportion was 0.47 (95%CI 0.16-0.78; p=0.003) for patients with ACS and 0.59 (95%CI 0.46-0.72; p Conclusions: A strategy of initial hsTn I at the time of ED presentation followed by early CCTA improved classification of ACS risk in patients with acute chest pain. |
| Databáze: | OpenAIRE |
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