CT or Invasive Coronary Angiography in Stable Chest Pain

Maurovich-Horvat, Pál; Bosserdt, Maria; Kofoed, Klaus F.; Rieckmann, Nina; Benedek, Theodora; Donnelly, Patrick; Rodríguez-Palomares, José F.; Ērglis, Andrejs; Štěchovský, Cyril; Šakalytė, Gintarė; Adić, Nada Čemerlić; Gutberlet, Matthias; Dodd, Jonathan D.; Díez, Ignacio; Davis, Gershan; Zimmermann, Elke; Kępka, Cezary; Vidaković, Radosav; Francone, Marco; Ilnicka-Suckiel, Małgorzata; Plank, Fabian; Knuuti, Juhani; Faria, Rita; Schröder, Stephen; Berry, Colin; Saba, Luca; Ruzsics, Balázs; Kubiak, Christine; Gutiérrez-Ibarluzea, Iñaki; Hansen, Kristian Schultz; Müller‐Nordhorn, Jacqueline; Merkely, Béla; Knudsen, Andreas Dehlbæk; Benedek, Imre; Orr, Clare; Valente, Filipa; Zvaigzne, Ligita; Suchánek, Vojtěch; Zajančkauskienė, Laura; Ađić, Filip; Woinke, Michael; Hensey, Mark; Lecumberri, Iñigo; Thwaite, Erica; Laule, Michael; Kruk, Mariusz; Nešković, Aleksandar N.; Mancone, Massimo; Kuśmierz, Donata; Feuchtner, Gudrun; Pietilä, Mikko; Ribeiro, Vasco Gama; Drosch, Tanja; Delles, Christian; Matta, Gildo; Fisher, Michael; Szilveszter, Bálint; Larsen, Linnea; Raţiu, Mihaela; Kelly, Stephanie; Blanco, Bruno García del; Rubio, Ainhoa Valle; Drobni, Zsófia; Jurlander, Birgit; Rodean, Ioana; Regan, Susan; Calabria, Hug Cuéllar; Boussoussou, Melinda; Engstrøm, Thomas; Hodaş, Roxana; Napp, Adriane E.; Haase, Robert; Feger, Sarah; Serna-­Higuita, Lina María; Neumann, Konrad; Dreger, Henryk; Rief, Matthias; Wieske, Viktoria; Estrella, Melanie; Martus, Peter; Dewey, Marc

doi:10.1056/nejmoa2200963

Cited by 158 publications

(64 citation statements)

References 31 publications

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“…31 32 Coronary CTA has a lower frequency of major procedure-related complications than invasive coronary angiography, with a similar risk of major adverse cardiovascular events, as shown in a recent multicentre trial comparing both modalities as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain. 33 Since its general safety could be confirmed by our study, which analysed an even larger population of real-world patients, coronary CTA can be considered an optimal diagnostic modality for CAD assessment in the outpatient setting.…”

Section: Limitationsmentioning

confidence: 54%

Factors influencing the safety of outpatient coronary CT angiography: a clinical registry study

André

Fortner²,

Emami³

et al. 2022

BMJ Open

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ObjectivesSince the safety of coronary CT angiography (CTA) is of great importance, especially with regard to widening indications and increasing morbidity, the aim of this study was to assess influencing factors.MethodsPatients undergoing coronary CTA in a third-generation dual-source CT in a radiological centre were included in a clinical registry. Up to 20 mg metoprolol was administered intravenously to attain a heart rate ≤65/min. Glyceryl trinitrate (GTN) was administered in doses of 0.8 mg and 0.4 mg. Blood pressure was measured before the administration and after the CTA.ResultsOut of 5500 consecutive patients (3194 men, 62.3 (54.9–70.0) years), adverse events occurred in 68 patients (1.2%) with mild anaphylactoid reactions (0.4%), vasovagal symptoms (0.3%) and extravasation (0.3%) being most frequent. Anti-allergic drugs were given in 17 patients, atropine in 3 patients and volume in 1 patient. Drug administration resulted in a significant mean arterial pressure decline (96.0 (88.3–106.0) vs 108.7 (99.7–117.3) mmHg; p<0.001). Patients who suffered systolic blood pressure drops >20 mmHg or >40 mmHg were older (66.5 (58.6–73.3) vs 60.5 (53.6–68.3) years; 70.2 (63.3–76.5) vs 62.1 (54.7–69.6) years), more often male (65.1% vs 54.4%; 68.9% vs 57.3%) and had higher Agatston score equivalents (83.0 (2.0–432.0) vs 15.0 (0.0–172.0); 163.0 (16.3–830.8) vs 25.0 (0.0–220.0); all p<0.001). GTN dose reduction lowered the fraction of patients suffering from blood pressure drops >20 mmHg or >40 mmHg from 34.5% to 27.4% and from 6.1% to 3.5% (both p<0.001), respectively. The proportion of coronary segments with impaired image quality did not differ significantly.ConclusionsCoronary CTA with intravenous beta-blocker administration is a safe procedure in an outpatient setting as adverse events are rare and mostly mild. Reduced GTN doses can further improve safety by lowering the rate of significant blood pressure drops, which occurred especially in elderly men with increased plaque burden.Trial registration numberNCT03815123.

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Section: Limitationsmentioning

confidence: 54%

Factors influencing the safety of outpatient coronary CT angiography: a clinical registry study

André

Fortner²,

Emami³

et al. 2022

BMJ Open

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“…In the presence of severe pulmonary decompensation, a computed tomography angiogram (CTA) showing no critical obstruction of proximal major coronary arteries would be all that is needed to exclude CAD in low-risk clinical presentations ( 54 ). In this regard, it is now clear that CTA is equal to or better than invasive coronary angiography for guiding treatment in intermediate-risk clinical presentations ( 55 , 56 ). Importantly, adding left ventricular end-systolic and end-diastolic imaging to coronary CTA would provide critical information for establishing the TTC diagnosis.…”

Section: The Heart In Covid-19mentioning

confidence: 99%

COVID-19 and the Heart: Could Transient Takotsubo Cardiomyopathy Be Related to the Pandemic by Incidence and Mechanisms?

Angelini

Postalian²,

Hernandez-Vila³

et al. 2022

Front. Cardiovasc. Med.

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Typical emergency hospital care during the COVID-19 pandemic has centered on pulmonary-focused services. Nonetheless, patients with COVID-19 frequently develop complications associated with the dysfunction of other organs, which may greatly affect prognosis. Preliminary evidence suggests that cardiovascular involvement is relatively frequent in COVID-19 and that it correlates with significant worsening of clinical status and mortality in infected patients. In this article, we summarize current knowledge on the cardiovascular effects of COVID-19. In particular, we focus on the association between COVID-19 and transient takotsubo cardiomyopathy (TTC)—two conditions that preliminarily seem epidemiologically associated—and we highlight cardiovascular changes that may help guide future investigations toward full discovery of this new, complex disease entity. We hypothesize that coronary endothelial dysfunction, along with septic state, inflammatory storm, hypercoagulability, endothelial necrosis, and small-vessel clotting, may represent a fundamental hidden link between COVID-19 and TTC. Furthermore, given the likelihood that new genetic mutations of coronaviruses or other organisms will cause similar pandemics and endemics in the future, we must be better prepared so that a substantial complication such as TTC can be more accurately recognized, its pathophysiology better understood, and its treatment made more justifiable, timely, and effective.

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“…Computed tomography angiography has no difference in MACE as compared to coronary angiography and as it is accompanied by significantly less complications, it may be an initial strategy (5).…”

Section: Dear Readersmentioning

confidence: 99%

From Editor-in-Chief: Our commitments, current and forthcoming jubilee issues, few updates on evidence-based knowledge, pandemics

Kudaiberdieva¹

2022

HVT

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CT or Invasive Coronary Angiography in Stable Chest Pain

Abstract: Drs. Maurovich-Horvat, Bosserdt, and Kofoed contributed equally to this article. This article was published on March 4, 2022, at NEJM.org.

Cited by 158 publications

References 31 publications

Factors influencing the safety of outpatient coronary CT angiography: a clinical registry study

Factors influencing the safety of outpatient coronary CT angiography: a clinical registry study

COVID-19 and the Heart: Could Transient Takotsubo Cardiomyopathy Be Related to the Pandemic by Incidence and Mechanisms?

From Editor-in-Chief: Our commitments, current and forthcoming jubilee issues, few updates on evidence-based knowledge, pandemics

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