Differentiating Between Acute Decompensated Aortic Stenosis and Myocardial Infarction.
Cardiovasc Revasc Med
; 43: 13-17, 2022 10.
Article
de En
| MEDLINE
| ID: mdl-35534348
ABSTRACT
BACKGROUND:
Patients with aortic stenosis (AS) are susceptible to myocardial ischemia and often present acutely, making it challenging to differentiate between a type 1 NSTEMI and acute decompensated aortic stenosis. This study aims to evaluate the diagnostic accuracy of Troponin T (TnT) (>5 fold above the upper limit of normal), ischemic ECG and angina, to predict a type 1 non-ST elevation myocardial infarction (NSTEMI) and obstructive coronary artery disease (CAD) among patients with severe AS and acute presentations.METHODS:
Patients with severe AS and acute symptoms angina (Canadian Cardiovascular Society Class 3/4), dyspnea (New York Heart Association 4) and/or syncope were included. The endpoints were a type 1 NSTEMI defined by the presence of a coronary thrombus or > 90% stenosis and obstructive CAD defined as >70% stenosis, by computed tomography (CT) and/or invasive coronary angiography (ICA).RESULTS:
Out of 273 patients, 6.2% had a type 1 NSTEMI. Positive TnT, ischemic ECG and angina demonstrated negative predictive values of 95%, 94% and 97% respectively and positive predictive values of 12%, 9% and 13% respectively. Specificity increased with all three metrics (95%), whilst sensitivity and positive predictive value reduced (18% and 19% respectively). 39.2% of patients had obstructive CAD. Positive TnT, ischemic ECG and angina demonstrated sensitivity of 64%, 34% and 41% respectively and specificity of 57%, 77% and 77% respectively.CONCLUSIONS:
Angina, ischemic ECG and positive TnT are common among patients with AS presenting acutely and often not associated with a type 1 NSTEMI. These metrics, if positive, cannot reliably differentiate between a type 1 NSTEMI and acute decompensated AS. Coronary imaging using either CT or ICA is necessary to make a definitive diagnosis of a type 1 NSTEMI in patients with severe AS.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Sténose aortique
/
Maladie des artères coronaires
/
Infarctus du myocarde sans sus-décalage du segment ST
/
Infarctus du myocarde
Type d'étude:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
Limites:
Humans
Pays/Région comme sujet:
America do norte
Langue:
En
Journal:
Cardiovasc Revasc Med
Sujet du journal:
ANGIOLOGIA
/
CARDIOLOGIA
Année:
2022
Type de document:
Article
Pays d'affiliation:
Royaume-Uni