CCTA in patients with positive troponin and low clinical suspicion for ACS: a useful diagnostic option to exclude

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James P Nugent1, Jun Wang2, Luck J Louis2

  • 1Radiology Department, Vancouver General Hospital, 889 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada. jamespnugent@outlook.com.

Emergency Radiology
|January 12, 2019
PubMed

Insights

Coronary CT angiography (CCTA) effectively ruled out obstructive coronary artery disease (CAD) in most emergency department patients with elevated troponin and low acute coronary syndrome (ACS) suspicion. This non-invasive imaging aids in expedited patient discharge.

Area of Science:

  • Cardiology
  • Radiology
  • Emergency Medicine

Background:

  • Elevated troponin levels in patients with non-classical acute coronary syndrome (ACS) presentations pose diagnostic challenges.
  • Coronary CT angiography (CCTA) is considered for patients with low clinical suspicion of ACS but elevated troponin.
  • Determining the utility of CCTA in this specific patient group is crucial for appropriate management and discharge.

Purpose of the Study:

  • To identify the most common diagnoses in patients with elevated troponin and low ACS suspicion who underwent CCTA.
  • To determine the rate of ACS among these patients.
  • To evaluate the diagnostic yield of CCTA in this population.

Main Methods:

  • Retrospective analysis of 491 patients undergoing CCTA in an emergency department (ED) between April 2015 and April 2017.
  • Inclusion criteria: elevated troponin (TnI > 0.045 μg/L) and atypical chest pain within 24 hours prior to imaging.
  • Eighty-four patients met criteria; scans performed on dual-source CT.

Main Results:

  • Absence of coronary artery disease (CAD) was found in 46.4% of patients.
  • Obstructive CAD (>50% stenosis) was identified in 13.1% of patients.
  • Nearly 57% of patients were discharged directly from the ED, with a median stay of approximately 16 hours.

Conclusions:

  • CCTA is valuable in excluding obstructive CAD in ED patients with elevated troponin and low ACS clinical suspicion.
  • The study demonstrated that 83% of patients with elevated troponin and low ACS suspicion did not have obstructive CAD.
  • CCTA facilitates non-invasive investigation and potential expedited discharge for a significant proportion of these patients.
Abstract

Keywords:
Acute coronary syndromeCoronary artery diseaseCoronary computed tomography angiographyTroponin

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