Most Read Articles
26 Nov 2019
Hypertension is associated with a high cardiovascular disease burden but does not appear to have any impact on symptoms or functional capacity during exercise treadmill test (ETT) in patients with aortic stenosis, results of a study have shown.
28 Nov 2019
Slideshow: Highlights from the American Heart Association (AHA) Scientific Sessions 2019
Elaine Soliven, 27 Nov 2019
High levels of trunk fat mass (FM) may be associated with an increased risk of cardiovascular disease (CVD)-related events such as coronary death, nonfatal myocardial infarction, or coronary heart disease in postmenopausal women with normal body mass index (BMI), according to a recent study presented at AHA 2019.
28 Oct 2019
The C-reactive protein (CRP)-to-albumin ratio (CAR) appears to be linked to the development of acute kidney injury in patients with ST elevation myocardial infarction (STEMI), a recent study has found.

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
26 Nov 2019
Hypertension is associated with a high cardiovascular disease burden but does not appear to have any impact on symptoms or functional capacity during exercise treadmill test (ETT) in patients with aortic stenosis, results of a study have shown.
28 Nov 2019
Slideshow: Highlights from the American Heart Association (AHA) Scientific Sessions 2019
Elaine Soliven, 27 Nov 2019
High levels of trunk fat mass (FM) may be associated with an increased risk of cardiovascular disease (CVD)-related events such as coronary death, nonfatal myocardial infarction, or coronary heart disease in postmenopausal women with normal body mass index (BMI), according to a recent study presented at AHA 2019.
28 Oct 2019
The C-reactive protein (CRP)-to-albumin ratio (CAR) appears to be linked to the development of acute kidney injury in patients with ST elevation myocardial infarction (STEMI), a recent study has found.