| Title: |
Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial |
| Authors: |
Wang, K-L; Roobottom, C; Smith, JE; Goodacre, S; Oatey, K; O’Brien, R; Storey, RF; Curzen, N; Keating, L; Kardos, A; Felmeden, D; Thokala, P; Mills, NL; Newby, DE; Gray, AJ |
| Publisher Information: |
England; Oxford University Press |
| Publication Year: |
2022 |
| Collection: |
PEARL (Plymouth Electronic Archiv & ResearchLibrary, Plymouth University) |
| Subject Terms: |
Acute coronary syndrome; Cardiac troponin; Computed tomography coronary angiography; Non-invasive testing |
| Description: |
Abstract Aims To evaluate the potential associations between presentation cardiac troponin and the clinical impact of early computed tomography coronary angiography (CTCA) in intermediate-risk patients with suspected acute coronary syndrome. Methods and results In a large multicentre randomized controlled trial of patients with intermediate-risk chest pain due to suspected acute coronary syndrome, early CTCA had no effect on the primary outcome—death or subsequent Type 1 or 4b myocardial infarction—but reduced the rate of invasive coronary angiography. In this pre-specified secondary analysis, cardiovascular testing and clinical outcomes were compared between those with or without cardiac troponin elevation at presentation. Of 1748 patients, 1004 (57%) had an elevated cardiac troponin concentration and 744 (43%) had a normal concentration. Patients with cardiac troponin elevation had a higher Global Registry of Acute Coronary Events score (132 vs. 91; P < 0.001) and were more likely to have obstructive coronary artery disease (59 vs. 33%; P < 0.001), non-invasive (72 vs. 52%; P < 0.001) and invasive (72 vs. 38%; P < 0.001) testing, coronary revascularization (47 vs. 15%; P < 0.001), and the primary outcome (8 vs. 3%; P = 0.007) at 1 year. However, there was no evidence that presentation cardiac troponin was associated with the relative effects of early CTCA on rates of non-invasive (Pinteraction = 0.33) and invasive (Pinteraction = 0.99) testing, coronary revascularization (Pinteraction = 0.57), or the primary outcome (Pinteraction = 0.41). Conclusions Presentation cardiac troponin had no demonstrable associations between the effects of early CTCA on reductions in non-invasive and invasive ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
570-579; Print; application/pdf |
| Language: |
English |
| ISSN: |
2048-8734 |
| Relation: |
E-ISSN:2048-8734; http://hdl.handle.net/10026.1/19383 |
| DOI: |
10.1093/ehjacc/zuac057 |
| Availability: |
http://hdl.handle.net/10026.1/19383; https://doi.org/10.1093/ehjacc/zuac057 |
| Accession Number: |
edsbas.850C821E |
| Database: |
BASE |