Most Read Articles
29 Mar 2020
Targeting a low-density lipoprotein cholesterol level <70 mg/dL following an ischaemic stroke of atherosclerotic origin helps to avoid one in four subsequent major vascular events without increasing the risk of intracranial haemorrhage over about 5 years of follow-up, according to data from the Treat Stroke to Target trial.
Pearl Toh, 12 Sep 2020
Early initiation of rhythm-control therapy led to a significantly reduced risk of major adverse cardiovascular (CV) outcomes compared with usual care (typically rate control) in patients with newly diagnosed atrial fibrillation (AF) at risk of stroke, reveals the EAST-AFNET 4* trial presented at ESC 2020.
Audrey Abella, 16 Sep 2020
The final results of EVAPORATE* reinforce the plaque-regressing potential of icosapent ethyl (IPE) in patients on statins for elevated triglycerides.
01 Feb 2020
High-intensity statin therapy appears to be seeing increased use in patients with acute coronary syndrome and leads to better lipid control, according to a recent Thailand study.

Initial imaging-guided strategy a safe gatekeeper for ICA in non-STEMI patients

29 Nov 2019

A novel strategy using either cardiovascular magnetic resonance imaging (CMR) or computed tomographic angiography (CTA) first in the diagnostic process of patients with non–ST-segment elevation myocardial infarction (non-STEMI) may minimize the use of invasive coronary angiography (ICA), according to a study.

“Patients with non–STEMI and elevated high-sensitivity cardiac troponin levels often routinely undergo ICA, but many do not have obstructive coronary artery disease (CAD),” the investigators said.

ICA was reduced in the CMR- (87 percent; p=0.001) and CTA-first strategies (66 percent; p<0.001) as compared with routine clinical care (100 percent), with comparable outcome (CMR vs routine: hazard ratio [HR], 0.78, 95 percent confidence interval [CI], 0.37–1.61; CTA vs routine: HR, 0.66, 95 percent CI, 0.31–1.42; CMR vs CTA: HR, 1.19, 95 percent CI, 0.53–2.66).

Obstructive CAD after ICA was detected in 61 percent of patients in the routine clinical care group, in 69 percent in the CMR-first group (p=0.308 vs routine) and in 85 percent in the CTA-first group (p=0.006 vs routine). Follow-up CMR and CTA were carried out in 67 percent and 13 percent of patients in the non-CMR and non-CTA groups, respectively, and led to a new diagnosis in 33 percent and 3 percent, respectively (p<0.001).

The investigators included 207 patients (mean age, 64 years; 62 percent male) with acute chest pain, elevated high-sensitivity cardiac troponin T levels (>14 ng/l) and inconclusive electrocardiogram in this randomized controlled trial and compared an initial CMR or CTA strategy with routine clinical care. Follow-up ICA was recommended when initial CMR or STA suggested myocardial ischaemia, infarction or obstructive CAD (≥70 percent stenosis). 

Referral to ICA during hospitalization was the primary efficacy endpoint, and 1-year outcomes (ie, major adverse cardiac events and complications) were the secondary safety endpoints.

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Most Read Articles
29 Mar 2020
Targeting a low-density lipoprotein cholesterol level <70 mg/dL following an ischaemic stroke of atherosclerotic origin helps to avoid one in four subsequent major vascular events without increasing the risk of intracranial haemorrhage over about 5 years of follow-up, according to data from the Treat Stroke to Target trial.
Pearl Toh, 12 Sep 2020
Early initiation of rhythm-control therapy led to a significantly reduced risk of major adverse cardiovascular (CV) outcomes compared with usual care (typically rate control) in patients with newly diagnosed atrial fibrillation (AF) at risk of stroke, reveals the EAST-AFNET 4* trial presented at ESC 2020.
Audrey Abella, 16 Sep 2020
The final results of EVAPORATE* reinforce the plaque-regressing potential of icosapent ethyl (IPE) in patients on statins for elevated triglycerides.
01 Feb 2020
High-intensity statin therapy appears to be seeing increased use in patients with acute coronary syndrome and leads to better lipid control, according to a recent Thailand study.