Observational studyEuropean radiology2025
Coronary computed tomography angiography improves assessment of patients with acute chest pain and inconclusively elevated high-sensitivity troponins.
Observational study in European radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03129659 (Coronary CT Angiography for Improved Assessment of Suspected Acute Coronary Syndrome With Inconclusive Diagnostic Work-up), which is not on this map. Cited by 6 papers.
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Coronary CT Angiography for Improved Assessment of Suspected Acute Coronary Syndrome With Inconclusive Diagnostic Work-up
Who cites it
6 citing papers in PubMed.
- Characteristics and outcomes of patients undergoing coronary computed tomography angiography for suspected acute coronary syndrome in the emergency department.The international journal of cardiovascular imaging · 2026Article
- Diagnostic performance between computed tomography angiography and high-sensitivity troponin for acute coronary syndrome in the emergency department: a systematic review and meta-analysis.Journal of thoracic disease · 2026Article
- Coronary Computed Tomography Angiography to Exclude Acute Coronary Syndrome in Low-Risk Chest Pain Patients.Journal of cardiovascular development and disease · 2025Review
- Acute Coronary Syndrome in Intensive Care Unit Patients: Troponin or Triglyceride Glucose Index Levels?Journal of clinical medicine · 2025Article
- Computed tomography angiography in the diagnosis of non-ST-elevation myocardial infarction: redefining our first line of defense.International journal of cardiology. Heart & vasculature · 2025Article
- Value of upfront coronary computed tomography angiography in patients with non-ST-segment elevation acute coronary syndrome.The international journal of cardiovascular imaging · 2025Article
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine whether coronary computed tomography angiography (CCTA) can improve the diagnostic work-up of patients with acute chest pain and inconclusively high-sensitivity troponins (hs-troponin).
methodsWe conducted a prospective, blinded, observational, multicentre study. Patients aged 30-80 years presenting to the emergency department with acute chest pain and inconclusively elevated hs-troponins were included and underwent CCTA. The primary outcome was the diagnostic accuracy of ≥ 50% stenosis on CCTA to identify patients with type-1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
resultsA total of 106 patients (mean age 65 ± 10, 29% women) were enrolled of whom 20 patients (19%) had an adjudicated diagnosis of type-1 NSTE-ACS. In 45 patients, CCTA revealed non-obstructive coronary artery disease (CAD) or no CAD. Sensitivity, specificity, negative predictive value (NPV), positive predictive value and area-under-the-curve (AUC) of ≥ 50% stenosis on CCTA to identify patients with type 1 NSTE-ACS, was 95% (95% confidence interval: 74-100), 56% (45-68), 98% (87-100), 35% (29-41) and 0.83 (0.73-0.94), respectively. When only coronary segments with a diameter ≥ 2 mm were considered for the adjudication of type 1 NSTE-ACS, the sensitivity and NPV increased to 100%. In 8 patients, CCTA enabled the detection of clinically relevant non-coronary findings.
conclusionThe absence of ≥ 50% coronary artery stenosis on CCTA can be used to rule out type 1 NSTE-ACS in acute chest pain patients with inconclusively elevated hs-troponins. Additionally, CCTA can help improve the diagnostic work-up by detecting other relevant conditions that cause acute chest pain and inconclusively elevated hs-troponins. CLINICAL RELEVANCE STATEMENT: Coronary CTA (CCTA) can safely rule out type 1 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients presenting to the ED with acute chest pain and inconclusively elevated hs-troponins, while also detecting other relevant non-coronary conditions.
trial registrationClinicaltrials.gov (NCT03129659). Registered on 26 April 2017 KEY POINTS: Acute chest discomfort is a common presenting complaint in the emergency department. CCTA achieved very high negative predictive values for type 1 NSTE-ACS in this population. CCTA can serve as an adjunct for evaluating equivocal ACS and evaluates for other pathology.
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