scholarly journals Coronary CT angiography for improved assessment of patients with acute chest pain and low-range positive high-sensitivity troponins: study protocol for a prospective, observational, multicentre study (COURSE trial)

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e049349
Author(s):  
Murat Arslan ◽  
Jeroen Schaap ◽  
Bart Van Gorsel ◽  
Ricardo PJ Budde ◽  
Sebastiaan CAM Bekkers ◽  
...  
Keyword(s):  
Chest Pain ◽  
The Netherlands ◽  
Multicentre Study ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Registration Number

IntroductionCurrent evaluation of patients suspected of a non-ST-elevation acute coronary syndrome (NSTE-ACS) involves the use of algorithms that incorporate clinical information, electrocardiogram (ECG) and high-sensitivity cardiac troponins (hs-troponins). While primarily designed to rule out NSTE-ACS safely, these algorithms can also be used for rule in of NSTE-ACS in some patients. Still, in a substantial number of patients, these algorithms do not provide a conclusive work-up. These patients often present with an atypical clinical profile and low-range positive hs-troponin values without a characteristic rise or fall pattern. They represent a heterogeneous group of patients with various underlying conditions; only a fraction (30%–40%) will eventually be diagnosed with a myocardial infarction. Uncertainty exists about the optimal diagnostic strategy and their management depends on the clinical perspective of the treating physician ranging from direct discharge to admission for invasive coronary angiography. Coronary CT angiography (CCTA) is a non-invasive test that has been shown to be safe, fast and reliable in the evaluation of coronary artery disease. In this study, we will determine the usefulness of CCTA in patients with acute chest pain and low-range positive hs-troponin values.Methods and analysisA prospective, double-blind, observational, multicentre study conducted in the Netherlands. Patients aged 30–80 years presenting to the emergency department with acute chest pain and a suspicion of NSTE-ACS, a normal or non-diagnostic ECG and low-range positive hs-troponins will be scheduled to undergo CCTA. The primary outcome is the diagnostic accuracy of CCTA for the diagnosis of NSTE-ACS at discharge, in terms of sensitivity and negative predictive value.Ethics and disseminationThis study was approved by the Medical Research Ethics Committee of Erasmus Medical Center in Rotterdam, the Netherlands (registration number MEC-2017-506). Written informed consent to participate will be obtained from all participants. This study’s findings will be published in a peer-reviewed journal.Trial registration numberClinicalTrials.gov (NCT03129659).

Myopericarditis in children and adolescent: is the elevated troponin and chest pain as alarming as we thought?

2021 ◽  
pp. 1-5
Author(s):  
Eviç Zeynep Başar ◽  
Dilek Borakay ◽  
Figen Akalın
Keyword(s):  
Differential Diagnosis ◽  
Chest Pain ◽  
Ct Angiography ◽  
Cardiac Mri ◽  
Cardiac Troponin ◽  
Coronary Ct Angiography ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Coronary Syndrome ◽  
Coronary Ct

Abstract Aim: When encountering adolescents with chest pain and a high troponin level but with no underlying coronary artery illness, it is advisable to consider myopericarditis. Though myopericarditis is a self-limiting, benign condition, it nevertheless causes anxiety in the patient and the family. Methods: Thirty-nine patients diagnosed with myopericarditis were included. We retrospectively analysed the demographic and clinical features, laboratory tests, echocardiography, electrocardiograms, MRI findings, coronary CT angiography, and conventional angiography findings in these patients. Results: Of the 39 patients (female/male = 4/35) aged 7–17 years, 66.6% had viral infection in the 2 weeks preceding presentation. Eleven patients were tested for high-sensitivity cardiac troponin I, 28 for high-sensitivity cardiac troponin T, and 10 patients were tested for both biomarkers. The median hs-TnI and hs-TnT values were 6.3 (0.05–29.9) ng/mL and 586 (51–9398) ng/L, respectively. Twenty-three patients showed ST changes on electrocardiography, of whom 11 had ST-elevation in the leads supporting left ventricular involvement. Coronary CT angiography and catheter angiography evaluations performed for differential diagnosis of coronary anomaly and acute coronary syndrome were normal. Cardiac MRI was conducted on 28 patients, and the results in 10 (35.7%) were suggestive of myopericarditis. Conclusions: Myopericarditis is common in the adolescent age group and is generally benign but should be carefully monitored for differential diagnosis and possible complications. Cardiac MRI, which has been used more frequently in recent years, has an important role in differential diagnosis and the follow-up of patients.

The role of coronary CT angiography for acute chest pain in the era of high-sensitivity troponins

2019 ◽  
Vol 13 (5) ◽  
pp. 267-273 ◽  
Author(s):  
Shengwen Yang ◽  
Lakshman Manjunath ◽  
Martin J. Willemink ◽  
Koen Nieman
Keyword(s):  
Chest Pain ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
Coronary Ct

Abstract 19818: Coronary CT Angiography for Suspected Acute Coronary Syndrome in the Era of High-Sensitivity Troponins - A Randomized Multicenter Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Admir Dedic ◽  
Jeroen Schaap ◽  
Evert Lamfers ◽  
Jeroen Lammers ◽  
Hans Post ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Ct Angiography ◽  
Primary Endpoint ◽  
Coronary Ct Angiography ◽  
High Sensitivity ◽  
Diagnostic Strategy ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Number Of Patients

Introduction: It is uncertain whether a diagnostic strategy supplemented by early coronary CT angiography (CCTA) is superior to contemporary standard optimal care (SOC) encompassing high sensitivity troponins for patients suspected of acute coronary syndrome (ACS) in the emergency department. Hypothesis: To assess whether a diagnostic strategysupplemented by early CCTA improves clinical effectiveness compared to contemporary SOC. Methods: In a prospective, open-label, multicentre, randomized trial, we enrolled patients presenting with symptoms suggestive of an ACSat the emergency department (ED) of five community and two university hospitals in the Netherlands. Exclusion criteria included the need for urgent cardiac catheterization, history of ACS or coronary revascularisation. The primary endpoint was the number of patients identified with significant coronary artery disease requiring revascularization within 30 days. Results: The study population consisted of 500 patients of whom 236 (47%) were women (mean age 54±10 years). There was no difference in the primary endpoint (22 [9%] patients underwent coronary revascularizationwithin 30 days in the CCTA group and 17 [7%] in the SOC group [p= 0·40]). Discharge from ED was not more frequent after CCTA (65% versus 59%, p= 0·16) and length of stay was similar(6·3 hours in both groups, p= 0·80). Direct medical costs were lower in the CCTA group (є337 versus є511, p<0·01). Less outpatient testing was seen with CCTA after index ED visit (10 [4%] versus 26 [10%], p<0·01). There was no difference in incidence of undetected ACS. Conclusions: A diagnostic strategy supplemented by early CCTAis safe, less expensive and averts outpatient testing. However, in the era of high-sensitivity troponins, CCTA does not identify more patients with significant CAD requiring coronary revascularization, nor does CCTAshorten hospital stay or allow for more direct discharge from the ED.

Coronary CT Angiography in Acute Chest Pain Syndromes

2010 ◽  
Vol 3 (6) ◽  
pp. 382-389
Author(s):  
Kavitha M. Chinnaiyan ◽  
Ryan D. Madder ◽  
James A. Goldstein
Keyword(s):  
Chest Pain ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
Coronary Ct ◽  
Pain Syndromes

scholarly journals Coronary CT Angiography in Emergency Department: Can We Use It?

2018 ◽  
Vol 38 (4) ◽  
pp. 234-238
Author(s):  
Sidhi Laksono Purwowiyoto
Keyword(s):  
Emergency Department ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
Pain Syndrome ◽  
Low Risk ◽  
Coronary Syndrome ◽  
Coronary Ct ◽  
Risk Patients ◽  
Early Imaging

Acute chest pain syndrome is the main cause of patients come to emergency department. Identifying those with anamneses, risk factors, physical examination, ECG and laboratory remain challenging to exclude the acute coronary syndrome, especially those with low risk probability. Early imaging examination is important for risk stratification of these groups. Utilization of coronary CT angiography quickly identifies a group of low risk patients and allows safe and expedited discharge.   Abstrak Sindroma nyeri dada akut merupakan penyebab utama pasien datang ke unit gawat darurat. Mengidentifikasi mereka dengan anamnesis, faktor risiko, pemeriksaan fisik, EKG dan laboratorium tetap menantang untuk dapat menyingkirkan sindroma koroner akut, terutama yang dengan probabilitas risiko rendah. Pemeriksaan pencitraan awal penting untuk stratifikasi risiko kelompok ini. Penggunaan angiografi CT koroner dengan cepat mengidentifikasi kelompok pasien dengan risiko rendah dan memungkinkan pasien dipulangkan secara aman dan cepat.

Abstract 46: Potential of Coronary CT Angiography to Optimize Medical Therapy in Patients Presenting With Acute Chest Pain

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Amit Pursnani ◽  
Christopher L Schlett ◽  
Pearl Zakroysky ◽  
Parmanand Singh ◽  
James L Januzzi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Secondary Prevention ◽  
Ct Angiography ◽  
Medical Therapy ◽  
Coronary Ct Angiography ◽  
Acute Chest Pain ◽  
Coronary Ct ◽  
Prevention Guidelines ◽  
Pain Patients

Background: Coronary artery disease (CAD) detected by coronary CT angiography (CCTA) independently predicts cardiovascular events. We assessed the potential of CCTA to tailor aspirin (ASA) and statin medical therapy in acute chest pain patients presenting to the emergency department. Methods: We included all patients from the Rule Out Myocardial Infarction Using Computer Assisted Tomography (ROMICAT) Trial. This prospective double-blinded observational cohort study included patients presenting with chest pain to the emergency department with low-intermediate risk for acute coronary syndrome (ACS). Patients underwent CCTA prior to admission, followed by standard evaluation. Caretakers were blinded to CCTA results. We assessed medical therapy at presentation and discharge, and determined concordance of CAD status by CCTA with medical therapy dictated by standard care. Results: Complete data on medical therapy was available in 358/368 patients (99%), (53±12 years, 61% men) of whom 7 had a contraindication to ASA and 11 to statin. Standard of care included stress testing in 71% of patients. Prescription of ASA and statins increased from admission to discharge (See Figure). At discharge, 33% of patients without CAD were on ASA and 14% were on statin. Conversely, 46% of patients with nonobstructive CAD by CCTA did not receive ASA and 59% did not receive statin at discharge. Only 66% of patients with obstructive CAD were on statin and ASA at discharge. Based on 2011 American College of Cardiology/American Heart Association secondary prevention guidelines, there was discordance between CAD status by CCTA and medical therapy in 51% of patients. Conclusions: CCTA has great potential to optimize adherence to secondary prevention guidelines in chest pain patients presenting to the emergency department.

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