The prognostic value of CT coronary angiography in patients attending hospital with troponin-negative acute chest pain and inconclusive exercise treadmill tests

Abstract

The presence of CAD assessed by CTCA is a strong predictor of adverse events in patients with troponin-negative acute chest pain and could potentially be used as an alternative, non-invasive risk stratifier in patients with inconclusive exercise tests.

Incidence and predictors of acute coronary syndrome within a year following a negative stress test—a false sense of security: is routine screening any useful?

“…These are features such as plaque size and vessel wall involvement. High risk calcium score calculated by Agatston units were related to worse outcome where for every 100 Agatston unit increase in calcium score there was an increased risk of adverse outcome and higher scores of more than were associated with worse outcomes (4). Presence of more than three segments with non-calcified plaques predicted adverse events, and the presence of coronary artery stenosis was the only significant predictor of adverse outcome directly related to the severity of the stenosis as it would be expected (4).…”

“…High risk calcium score calculated by Agatston units were related to worse outcome where for every 100 Agatston unit increase in calcium score there was an increased risk of adverse outcome and higher scores of more than were associated with worse outcomes (4). Presence of more than three segments with non-calcified plaques predicted adverse events, and the presence of coronary artery stenosis was the only significant predictor of adverse outcome directly related to the severity of the stenosis as it would be expected (4). It is also important to mention the ability of CTCA to possess a good prognostic value in identification of non-obstructive CAD and by combining it with the cases of more than 400 Agatston units it can correctly identify patients at higher risk of MI and the score based on CT can help distinguish among patients with non-obstructive CAD and those at higher risk (22).…”

“…This brings up the question that despite ETT being widely available, there are a significant portion of the patient population who may not be able to undergo this test modality, for example, the population that cannot achieve 85% of age-predicted maximal heart rat, poor mobility, or existing ECG abnormalities at rest such a left bundle branch block (4,7). While ETT has proven to have a great negative predictive value, there have been reports of it missing acute myocardial infarctions on rare occasions which can prove to be costly for the patient.…”

“…Thus, finding a proper method for risk stratification and screening would serve as a key stepping stone. There have been multiple methods of assessment of chest pain under investigation for facilitation of this process which include: exercise treadmill test (ETT), exercise echocardiography, myocardial perfusion imaging nuclear scan, magnetic resonance imaging (MRI), and computer tomography angiography (2)(3)(4)(5). Presently, patients presenting to the ED with acute chest pain undergo the protocol to rule out acute coronary syndrome (ACS) with electrocardiogram (ECG), cardiac enzymes and further testing.…”

On the use of computed tomography in cardiac imaging

“…All exams in patients with known CAD or other cardiac disease were excluded, as were all exams with suboptimal image quality. Thus, the patient selection process was similar to several other studies with similar objectives (24)(25)(26)(27)(95)(96)(97).…”