Copeptin in acute chest pain: identification of acute coronary syndrome and obstructive coronary artery disease on coronary CT angiography

Introduction: Acute chest pain, ST-changes on EKG and elevation of cardiac troponin in patients without obstructive coronary artery disease represent a clinical challenge. Cardiovascular magnetic resonance (CMR) can be used to diagnose causes other than obstructive coronary artery disease. Hypothesis: The aim of this study was to evaluate the usefulness of CMR to diagnose conditions in the emergency room that otherwise would be considered as acute coronary syndrome (ACS) in patients with normal coronary arteries. Methods: Fifty-nine patients with chest pain and/or electrocardiographic changes and elevated troponin concentration occurring in the absence of significant coronary artery stenosis (normal or stenosis < 50% of the vessel diameter on angiography, computed tomography or both) were selected and prospectively submitted to CMR exam in a 1.5T Philips scanner between May 2013 and December 2014. Ventricular function by cine MR with SSFP technique, and myocardial tissue characterization using late gadolinium enhancement (LGE) were evaluated in patients referred to the Emergency room. LGE patterns were analyzed visually by 2 observers and classified as ischemic (involving subendocardial layer) and nonischemic (multifocal, not involving subendocardial layer, non coronary distribution). Results: Among 59 patients, all with interpretable CMR exams, diagnosis of acute myocarditis was found in 39% of patients, acute myocardial infarction in 17% and Takotsubo cardiomyopathy in 12%. Other final diagnoses were hypertrophic cardiomyopathy (5%), coronary embolism (10%), cardiomyopathy (3%), sepsis (4%), aortic stenosis (3%) and non-compaction myocardium (2%). In 38 patients (66%), CMR changed the initial ACS diagnosis to another final diagnosis. Additionally,3 patients primarily considered as having myocarditis received a final diagnosis of myocardial infarction. Conclusions: In the study, 66% of patients had their primary diagnosis and treatment changed after CMR study. The presence, distribution and pattern of late gadolinium enhancement by CMR were crucial in establishing a precise final diagnosis and appropriately changing patient management.

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Novel Biomarkers: Utility in Patients with Acute Chest Pain and Relationship to Coronary Artery Disease on Coronary CT Angiography

Current Cardiovascular Imaging Reports ◽

10.1007/s12410-014-9277-x ◽

2014 ◽

Vol 7 (7) ◽

Author(s):

Adefolakemi Babatunde ◽

Asim Rizvi ◽

Quynh A. Truong

Keyword(s):

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Ct Angiography ◽

Coronary Ct Angiography ◽

Acute Chest Pain ◽

Coronary Ct ◽

Novel Biomarkers ◽

Artery Disease

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ABSENCE OF CORONARY ARTERY CALCIUM DOES NOT FULLY EXCLUDE OBSTRUCTIVE CORONARY ARTERY DISEASE AND FUTURE ADVERSE EVENTS AMONG PATIENTS REFERRED FOR CARDIAC CT ANGIOGRAPHY: RESULTS FROM 17,528 PATIENTS IN THE CONFIRM REGISTRY (CORONARY CT ANGIOGRAPHY EVALUATION FOR CLINICAL OUTCOMES: AN INTERNATIONAL MULTICENTER REGISTRY)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)62035-4 ◽

2011 ◽

Vol 57 (14) ◽

pp. E2035

Author(s):

Todd C. Villines ◽

Edward Hulten ◽

Alison Dunning ◽

Leslee J. Shaw ◽

Stephan Achenbach ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Ct Angiography ◽

Coronary Ct Angiography ◽

Cardiac Ct ◽

Obstructive Coronary Artery Disease ◽

Coronary Ct ◽

Artery Disease ◽

International Multicenter ◽

Multicenter Registry

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Abstract 20047: Validation of the Simple Acute Coronary Syndrome (SACS) Score for Identifying Obstructive Coronary Artery Disease

Circulation ◽

10.1161/circ.132.suppl_3.20047 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Daniel Matta ◽

Christina Marsalisi ◽

Wayne Ruppert ◽

Ravi Korabathina

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Cardiac Catheterization ◽

Obstructive Coronary Artery Disease ◽

Retrospective Chart Review ◽

Study Endpoint ◽

Coronary Syndrome ◽

Artery Disease ◽

Scoring Tool

Background: Each year, up to 136,000 individuals suffering from acute coronary syndrome (ACS) are misdiagnosed and discharged from our nations’ emergency departments. We developed the Simple Acute Coronary Syndrome (SACS) score that tabulates a patient’s symptoms, ECG findings, risk factors, and cardiac markers (Figure 1). Our aim was to validate this novel scoring tool in its ability to identify the presence of obstructive coronary artery disease (CAD). Methods: A single-center retrospective chart review was performed after institutional review board approval. The charts of 42 consecutive patients who presented with ACS and who were treated with an invasive strategy were reviewed. Scores were calculated for each patient using the SACS tool as well as the Modified Thrombolysis in Myocardial Infarction (TIMI) ACS calculator. The study endpoint was the presence of at least one vessel obstructive CAD at cardiac catheterization. Descriptive statistics were employed. Results: The stratification of SACS and Modified TIMI scores for each of the 42 ACS patients is shown in Figure 2. In patients with a SACS score that was less than 3, none of these patients were found to have obstructive CAD at cardiac catheterization. For patients with a SACS score of 4 or higher, 100% of these patients were shown to have obstructive CAD. For patients with Modified TIMI scores of 1 and 2, 3/11 (27%) were found to have obstructive CAD. Conclusions: The novel SACS scoring system identifies ACS patients who will have obstructive CAD more reliably than more traditional scoring systems. The SACS scoring tool needs to be validated in larger scale studies.

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