Initial Imaging-Guided Strategy Versus Routine Care in Patients With Non–ST-Segment Elevation Myocardial Infarction

Smulders, Martijn W.; Kietselaer, Bas; Wildberger, Joachim E.; Dagnelie, Pieter C.; Rocca, Hans‐Peter Brunner‐La; Mingels, Alma M.A.; Cauteren, Yvonne J. M. van; Theunissen, Ruud; Post, Mark J.; Schalla, Simon; Kuijk, Sander M. J. van; Das, Marco; Kim, Raymond J.; Crijns, Harry J.G.M.; Bekkers, Sebastiaan C.A.M.

doi:10.1016/j.jacc.2019.09.027

Cited by 69 publications

(41 citation statements)

References 29 publications

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“…On the other hand, CCTA should be reserved to patients at low and intermediate risk of ACS with equivocal presentation where it can replace ICA in ruling-out ACS thanks to its excellent negative predictive value. 100,101 This may help avoid unnecessary exposure to all members of the cardiac catheterization laboratory, decrease personal protective equipment utilization and limit patient procedural risk. 99…”

Section: Coronary Ct Angiography In Ruling-out Acsmentioning

confidence: 99%

Role of computed tomography in COVID-19

Pontone

Scafuri

Mancini

et al. 2021

Journal of Cardiovascular Computed Tomography

118

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Coronavirus disease 2019 (COVID-19) has become a rapid worldwide pandemic. While COVID-19 primarily manifests as an interstitial pneumonia and severe acute respiratory distress syndrome, severe involvement of other organs has been documented. In this article, we will review the role of non-contrast chest computed tomography in the diagnosis, follow-up and prognosis of patients affected by COVID-19 pneumonia with a detailed description of the imaging findings that may be encountered. Given that patients with COVID-19 may also suffer from coagulopathy, we will discuss the role of CT pulmonary angiography in the detection of acute pulmonary embolism. Finally, we will describe more advanced applications of CT in the differential diagnosis of myocardial injury with an emphasis on ruling out acute coronary syndrome and myocarditis.

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Section: Coronary Ct Angiography In Ruling-out Acsmentioning

confidence: 99%

Role of computed tomography in COVID-19

Pontone

Scafuri

Mancini

et al. 2021

Journal of Cardiovascular Computed Tomography

118

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“…Specifically, 30% of patients had no obstructive CAD, and were accurately identified by coronary CTA. The CARMENTA (The Supplementary Role of Non-invasive Imaging to Routine Clinical Practice in Suspected Non-ST-elevation Myocardial Infarction) randomized controlled trial 16 evaluated whether coronary CTA or CMR can serve as a gatekeeper to invasive angiography among 207 patients with NSTEMI. A coronary CTA-first strategy was able to safely defer invasive coronary angiography in about one-third of patients.…”

Section: Role Of Coronary Cta In Acute Chest Pain and Elevated Troponmentioning

confidence: 99%

Use of cardiac CT amidst the COVID-19 pandemic and beyond: North American perspective

Singh

Choi

Leipsic

et al. 2021

Journal of Cardiovascular Computed Tomography

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“…This is a sub-analysis of the CARMENTA trial, a singlecenter randomized controlled trial [9]. In brief, CAR-MENTA included 207 consecutive patients without a known history of CAD or cardiomyopathy who were admitted because of acute chest pain, normal or nondiagnostic electrocardiogram and high sensitivity cardiac troponin T (hs-cTnT) values > 14 ng/L, at baseline or 3 h after presentation (i.e., suspected NSTEMI).…”

Section: Study Populationmentioning

confidence: 99%

“…All remaining baseline characteristics were comparable between both subgroups (Tables 1 and 2). Most patients (90%) were at low-to-intermediate risk for 6-month death or MI with a GRACE risk-score of 114 ± 22 and were representative for the total CARMENTA population [9]. The median time between CMR and ICA was 1 day [1-3 days].…”

Section: Study Populationmentioning

confidence: 99%

Cardiovascular magnetic resonance accurately detects obstructive coronary artery disease in suspected non-ST elevation myocardial infarction: a sub-analysis of the CARMENTA Trial

Cauteren

Smulders

Theunissen

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Invasive coronary angiography (ICA) is still the reference test in suspected non-ST elevation myocardial infarction (NSTEMI), although a substantial number of patients do not have obstructive coronary artery disease (CAD). Early cardiovascular magnetic resonance (CMR) may be a useful gatekeeper for ICA in this setting. The main objective was to investigate the accuracy of CMR to detect obstructive CAD in NSTEMI. Methods This study is a sub-analysis of a randomized controlled trial investigating whether a non-invasive imaging-first strategy safely reduced the number of ICA compared to routine clinical care in suspected NSTEMI (acute chest pain, non-diagnostic electrocardiogram, high sensitivity troponin T > 14 ng/L), and included 51 patients who underwent CMR prior to ICA. A stepwise approach was used to assess the diagnostic accuracy of CMR to detect (1) obstructive CAD (diameter stenosis ≥ 70% by ICA) and (2) an adjudicated final diagnosis of acute coronary syndrome (ACS). First, in all patients the combination of cine, T2-weighted and late gadolinium enhancement (LGE) imaging was evaluated for the presence of abnormalities consistent with a coronary etiology in any sequence. Hereafter and only when the scan was normal or equivocal, adenosine stress-perfusion CMR was added. Results Of 51 patients included (63 ± 10 years, 51% male), 34 (67%) had obstructive CAD by ICA. The sensitivity, specificity and overall accuracy of the first step to diagnose obstructive CAD were 79%, 71% and 77%, respectively. Additional vasodilator stress-perfusion CMR was performed in 19 patients and combined with step one resulted in an overall sensitivity of 97%, specificity of 65% and accuracy of 86%. Of the remaining 17 patients with non-obstructive CAD, 4 (24%) had evidence for a myocardial infarction on LGE, explaining the modest specificity. The sensitivity, specificity and overall accuracy to diagnose ACS (n = 43) were 88%, 88% and 88%, respectively. Conclusion CMR accurately detects obstructive CAD and ACS in suspected NSTEMI. Non-obstructive CAD is common with CMR still identifying an infarction in almost one-quarter of patients. CMR should be considered as an early diagnostic approach in suspected NSTEMI. Trial registration. The CARMENTA trial has been registered at ClinicalTrials.gov with identifier NCT01559467.

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Initial Imaging-Guided Strategy Versus Routine Care in Patients With Non–ST-Segment Elevation Myocardial Infarction

Cited by 69 publications

References 29 publications

Role of computed tomography in COVID-19

Role of computed tomography in COVID-19

Use of cardiac CT amidst the COVID-19 pandemic and beyond: North American perspective

Cardiovascular magnetic resonance accurately detects obstructive coronary artery disease in suspected non-ST elevation myocardial infarction: a sub-analysis of the CARMENTA Trial

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