Diagnostic Work-up of Acute Coronary Syndrome: The interplay between high-sensitivity troponins and coronary CT angiography

In this thesis the interplay between high-sensitivity cardiac troponin T and coronary computed tomography angiography (CCTA) in the assessment of patients presenting with acute chest pain to the emergency department (ED) is evaluated. In Part I we discuss the new role of non-invasive imaging, such as CCTA, as a gatekeeper for invasive coronary angiography in the era of high-sensitivity cardiac troponin assays and give an overview of the use of CCTA in suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients. In Part II we investigate various risk stratification strategies and sex-associated differences in a low-risk suspected NSTE-ACS population. Finally, in Part III of the thesis we focus on the clinical value of new accelerated diagnostic protocols with high-sensitivity cardiac troponin assays for suspected NSTE-ACS patients and the role of CCTA in those with non-conclusive work-up.