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Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial.
Wang, Kang Ling; Roobottom, Carl; Smith, Jason E; Goodacre, Steve; Oatey, Katherine; O'Brien, Rachel; Storey, Robert F; Curzen, Nick; Keating, Liza; Kardos, Attila; Felmeden, Dirk; Thokala, Praveen; Mills, Nicholas L; Newby, David E; Gray, Alasdair J.
Afiliação
  • Wang KL; Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
  • Roobottom C; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
  • Smith JE; General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Goodacre S; Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK.
  • Oatey K; Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK.
  • O'Brien R; School of Health and Related Research, University of Sheffield, Sheffield, UK.
  • Storey RF; Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.
  • Curzen N; Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • Keating L; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
  • Kardos A; Faculty of Medicine, University of Southampton, Southampton, UK.
  • Felmeden D; Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
  • Thokala P; Department of Emergency Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK.
  • Mills NL; Translational Cardiovascular Research Group, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK.
  • Newby DE; Faculty of Medicine and Health Science, University of Buckingham, Buckingham, UK.
  • Gray AJ; Department of Cardiology, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
Eur Heart J Acute Cardiovasc Care ; 11(7): 570-579, 2022 Jul 21.
Article em En | MEDLINE | ID: mdl-35642464
AIMS: To evaluate the potential associations between presentation cardiac troponin and the clinical impact of early computed tomography coronary angiography (CTCA) in intermediate-risk patients with suspected acute coronary syndrome. METHODS AND RESULTS: In a large multicentre randomized controlled trial of patients with intermediate-risk chest pain due to suspected acute coronary syndrome, early CTCA had no effect on the primary outcome-death or subsequent Type 1 or 4b myocardial infarction-but reduced the rate of invasive coronary angiography. In this pre-specified secondary analysis, cardiovascular testing and clinical outcomes were compared between those with or without cardiac troponin elevation at presentation. Of 1748 patients, 1004 (57%) had an elevated cardiac troponin concentration and 744 (43%) had a normal concentration. Patients with cardiac troponin elevation had a higher Global Registry of Acute Coronary Events score (132 vs. 91; P < 0.001) and were more likely to have obstructive coronary artery disease (59 vs. 33%; P < 0.001), non-invasive (72 vs. 52%; P < 0.001) and invasive (72 vs. 38%; P < 0.001) testing, coronary revascularization (47 vs. 15%; P < 0.001), and the primary outcome (8 vs. 3%; P = 0.007) at 1 year. However, there was no evidence that presentation cardiac troponin was associated with the relative effects of early CTCA on rates of non-invasive (Pinteraction = 0.33) and invasive (Pinteraction = 0.99) testing, coronary revascularization (Pinteraction = 0.57), or the primary outcome (Pinteraction = 0.41). CONCLUSION: Presentation cardiac troponin had no demonstrable associations between the effects of early CTCA on reductions in non-invasive and invasive testing, or the lack of effect on coronary revascularization or the primary outcome in intermediate-risk patients with suspected acute coronary syndrome.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Síndrome Coronariana Aguda Tipo de estudo: Clinical_trials / Diagnostic_studies Limite: Humans Idioma: En Revista: Eur Heart J Acute Cardiovasc Care Ano de publicação: 2022 Tipo de documento: Article País de publicação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Síndrome Coronariana Aguda Tipo de estudo: Clinical_trials / Diagnostic_studies Limite: Humans Idioma: En Revista: Eur Heart J Acute Cardiovasc Care Ano de publicação: 2022 Tipo de documento: Article País de publicação: Reino Unido