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Published on: August 9, 2024
Diagnostic Performance of Coronary Tomography Angiography and Serial Measurements of Sensitive Cardiac Troponin in
Alexandre de Matos Soeiro1, Bruno Biselli1, Tatiana C A T Leal1
1Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
Insights
Coronary tomography angiography (CTA) is more effective than sensitive troponin in detecting significant coronary artery disease in intermediate-risk patients with chest pain. CTA demonstrated higher accuracy in identifying coronary lesions and predicting clinical outcomes.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Coronary tomography angiography (CTA) is primarily used for low-risk chest pain patients.
- Limited data exist on CTA performance in intermediate-risk populations.
Purpose of the Study:
- To assess the diagnostic performance of serial sensitive troponin measurements and CTA in intermediate-risk patients presenting with chest pain.
- To compare the accuracy of CTA and troponin in detecting significant coronary artery disease and predicting 30-day clinical outcomes.
Main Methods:
- Prospective study of 100 intermediate-risk patients (TIMI score 3-4) with chest pain and negative initial troponin.
- All patients underwent CTA; those with ≥50% stenosis were referred for invasive angiography.
- Clinical outcomes (hospitalization, death, myocardial infarction) were assessed at 30 days.
Main Results:
- Coronary stenosis ≥50% was detected by CTA in 38% of patients.
- CTA showed high accuracy (91%) in detecting significant coronary lesions and predicting clinical events.
- Sensitive troponin measures demonstrated lower accuracy (60%) with poor agreement with CTA (kappa = 0.022).
Conclusions:
- Coronary tomography angiography (CTA) significantly outperforms sensitive troponin assays for diagnosing significant coronary artery disease in intermediate-risk chest pain patients.
- CTA is a valuable tool for risk stratification and management decisions in this patient group.
Background:
Coronary tomography angiography (CTA) has been mainly used for chest pain evaluation in low-risk patients, and few data exist regarding patients at intermediate risk.
Objective:
To evaluate the performance of serial measures of sensitive troponin and CTA in intermediate-risk patients.
Methods:
A total of 100 patients with chest pain, TIMI risk scores of 3 or 4, and negative troponin were prospectively included. All patients underwent CTA and those with coronary stenosis ≥ 50% were referred to invasive coronary angiography. Patients with coronary lesions <50% were discharged and contacted 30 days later by a telephone call to assess clinical outcomes. Outcomes were hospitalization, death, and myocardial infarction at 30 days. The comparison between methods was performed by Kappa agreement test. The performance of troponin measures and CTA for detecting significant coronary lesions and clinical outcomes was calculated. Results were considered statistically significant when p < 0.05.
Results:
Coronary stenosis ≥ 50% on CTA was found in 38% of patients and significant coronary lesions on coronary angiography were found in 31 patients. Two clinical events were observed. Kappa agreement analysis showed low agreement between troponin measures and CTA in the detection of significant coronary lesions (kappa = 0.022, p = 0.78). The performance of CTA for detecting significant coronary lesions on coronary angiography or for predicting clinical events at 30 days was better than sensitive troponin measures (accuracy of 91% versus 60%).
Conclusion:
CTA performed better than sensitive troponin measures in the detection of significant coronary disease in patients with chest pain and intermediate risk for cardiovascular events.
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