Targeted Use of Computed Tomographic Coronary Angiography in Acute Chest Pain.
Kuan Ken Lee, Ryan Wereski, David Lowe et al.
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In 30 seconds
This multicenter randomized controlled trial compared outpatient CT coronary angiography-guided care with standard care in emergency-department patients whose myocardial infarction had been ruled out but whose high-sensitivity troponin indicated intermediate cardiovascular risk. Among 3170 participants, after a median of 3.0 years, myocardial infarction or cardiac death occurred in 7.1% of the CT angiography group and 7.3% of the standard-care group (adjusted hazard ratio, 0.95; 95% confidence interval, 0.73 to 1.23; P = 0.71). Routine CT angiography-guided management did not lower the incidence of the primary outcome.
Key findings
- The primary outcome occurred in 112 participants (7.1%) assigned to CT angiography-guided care and 116 (7.3%) assigned to standard care.
- The adjusted hazard ratio was 0.95 (95% confidence interval, 0.73 to 1.23; P = 0.71), showing no significant difference in myocardial infarction or cardiac death.
- By 90 days, CT coronary angiography had been performed in 92.1% of the intervention group and 2.2% of the standard-care group.
- Seven participants (0.4%) had a CT coronary angiography-related adverse event.
Why it matters
Patients discharged after myocardial infarction is ruled out may still have cardiovascular risk, making the value of further investigation clinically important. In this trial, routinely directing care with CT coronary angiography did not reduce subsequent myocardial infarction or cardiac death compared with standard care, informing assessment of this strategy in a defined intermediate-risk population.
What to keep in mind
The findings apply to patients with myocardial infarction ruled out and intermediate risk as defined by high-sensitivity troponin testing; the abstract does not establish effects in other populations.