| 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, J.E.; Goodacre, S.; Oatey, K.; O'Brien, R.; Storey, R.F.; Curzen, N.; Keating, L.; Kardos, A.; Felmeden, D.; Thokala, P.; Mills, N.L.; Newby, D.E.; Gray, A.J. |
| Publisher Information: |
SAGE Publications |
| Publication Year: |
2022 |
| Collection: |
White Rose Research Online (Universities of Leeds, Sheffield & York) |
| Description: |
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 testing, or the lack of effect on coronary revascularization or the primary outcome in intermediate-risk patients with suspected acute coronary syndrome. |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| ISSN: |
2048-8726 |
| Relation: |
https://eprints.whiterose.ac.uk/id/eprint/187878/1/zuac057.pdf; Wang, K.-L., Roobottom, C., Smith, J.E. et al. (12 more authors) (2022) 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. European Heart Journal: Acute Cardiovascular Care, 11 (7). pp. 570-579. ISSN: 2048-8726 |
| Availability: |
https://eprints.whiterose.ac.uk/id/eprint/187878/; https://eprints.whiterose.ac.uk/id/eprint/187878/1/zuac057.pdf |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.C64CAED9 |
| Database: |
BASE |