Undetectable High-Sensitivity Troponin T as a Gatekeeper for Coronary Computed Tomography Angiography in Patients Suspected of Acute Coronary Syndrome

Murat Arslan; Jeroen Schaap; Pleunie P.M. Rood; Koen Nieman; Ricardo P.J. Budde; Bas M. Van Dalen; Mohamed Attrach; Eric A. Dubois; Admir Dedic

doi:10.1159/000517897

Undetectable High-Sensitivity Troponin T as a Gatekeeper for Coronary Computed Tomography Angiography in Patients Suspected of Acute Coronary Syndrome

Murat Arslan^*, Jeroen Schaap, Pleunie P.M. Rood, Koen Nieman, Ricardo P.J. Budde, Bas M. Van Dalen, Mohamed Attrach, Eric A. Dubois, Admir Dedic

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objectives: The aim of this study was to characterize the safety and efficiency of a strategy employing the limit of detection (LoD) of high-sensitivity troponin T (hs-TnT) as a gatekeeper for coronary computed tomography angiography (CCTA) in suspected acute coronary syndrome (ACS) patients in the emergency department (ED). Methods: We included suspected ACS patients who underwent CCTA and were evaluated with hs-TnT. Patients were categorized as below the LoD and at or above the LoD. The primary outcome was 30-day major adverse cardiac events (MACEs), defined as all-cause mortality, ACS, or coronary revascularization. Results: The study population consisted of 177 patients (mean age 55 ± 10 years, 50.3% women), and 16 (9.0%) patients reached the primary outcome. None of the patients died, while 13 had an adjudicated diagnosis of ACS, and 3 underwent elective coronary revascularization. There were 77 patients (44%) with an hs-TnT value below the LoD (MACEs; n = 1 [1.3%]) and 100 (56%) with at or above the LoD levels (MACEs; n = 15 [15%]). None of 67 patients with an hs-TnT value below the LoD and <50% stenosis on CCTA experienced MACEs. Out of the 10 patients with an hs-TnT value below the LoD and ≥50% stenosis on CCTA, 1 patient underwent elective percutaneous coronary revascularization. In patients with an hs-TnT value at or above the LoD, 74 patients had <50% stenosis on CCTA, and 2 patients (3%) were diagnosed with myocardial infarction without obstructive coronary artery disease confirmed on invasive angiography. Thirteen (50%) patients with an hs-TnT value at or above the LoD and ≥50% stenosis on CCTA experienced MACEs (11 ACS and 2 elective percutaneous coronary revascularizations). Conclusion: Our findings support that implementing the LoD of hs-TnT as a gatekeeper may reduce the need for CCTA in suspected ACS patients in the ED.

Original language	English
Pages (from-to)	713-719
Number of pages	7
Journal	Cardiology (Switzerland)
Volume	146
Issue number	6
DOIs	https://doi.org/10.1159/000517897
Publication status	Published - 1 Dec 2021

Bibliographical note

Funding Information:
This work was supported by a grant from Erasmus MC and a research grant from the Erasmus MC Thorax Foundation (project grant B4). The sponsor had no role in study design; in the collection, analysis, and interpretation of data; in writing the report; and in the decision to submit the article for publication.

Funding Information:
Koen Nieman was supported by a grant from the Dutch Heart Foundation (NHS 2014T061) and received grants from Siemens Medical Solutions, GE Healthcare, Bayer Healthcare, and HeartFlow outside the submitted work. All the other authors report no relationships relevant to the contents of this study to disclose.

Publisher Copyright:
© 2021

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Undetectable High-Sensitivity Troponin T as a Gatekeeper forFinal published version, 206 KBLicence: CC BY-NC

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@article{b3c4a1b95beb4446950651f2e018b34b,

title = "Undetectable High-Sensitivity Troponin T as a Gatekeeper for Coronary Computed Tomography Angiography in Patients Suspected of Acute Coronary Syndrome",

abstract = "Objectives: The aim of this study was to characterize the safety and efficiency of a strategy employing the limit of detection (LoD) of high-sensitivity troponin T (hs-TnT) as a gatekeeper for coronary computed tomography angiography (CCTA) in suspected acute coronary syndrome (ACS) patients in the emergency department (ED). Methods: We included suspected ACS patients who underwent CCTA and were evaluated with hs-TnT. Patients were categorized as below the LoD and at or above the LoD. The primary outcome was 30-day major adverse cardiac events (MACEs), defined as all-cause mortality, ACS, or coronary revascularization. Results: The study population consisted of 177 patients (mean age 55 ± 10 years, 50.3% women), and 16 (9.0%) patients reached the primary outcome. None of the patients died, while 13 had an adjudicated diagnosis of ACS, and 3 underwent elective coronary revascularization. There were 77 patients (44%) with an hs-TnT value below the LoD (MACEs; n = 1 [1.3%]) and 100 (56%) with at or above the LoD levels (MACEs; n = 15 [15%]). None of 67 patients with an hs-TnT value below the LoD and <50% stenosis on CCTA experienced MACEs. Out of the 10 patients with an hs-TnT value below the LoD and ≥50% stenosis on CCTA, 1 patient underwent elective percutaneous coronary revascularization. In patients with an hs-TnT value at or above the LoD, 74 patients had <50% stenosis on CCTA, and 2 patients (3%) were diagnosed with myocardial infarction without obstructive coronary artery disease confirmed on invasive angiography. Thirteen (50%) patients with an hs-TnT value at or above the LoD and ≥50% stenosis on CCTA experienced MACEs (11 ACS and 2 elective percutaneous coronary revascularizations). Conclusion: Our findings support that implementing the LoD of hs-TnT as a gatekeeper may reduce the need for CCTA in suspected ACS patients in the ED. ",

author = "Murat Arslan and Jeroen Schaap and Rood, {Pleunie P.M.} and Koen Nieman and Budde, {Ricardo P.J.} and {Van Dalen}, {Bas M.} and Mohamed Attrach and Dubois, {Eric A.} and Admir Dedic",

note = "Funding Information: This work was supported by a grant from Erasmus MC and a research grant from the Erasmus MC Thorax Foundation (project grant B4). The sponsor had no role in study design; in the collection, analysis, and interpretation of data; in writing the report; and in the decision to submit the article for publication. Funding Information: Koen Nieman was supported by a grant from the Dutch Heart Foundation (NHS 2014T061) and received grants from Siemens Medical Solutions, GE Healthcare, Bayer Healthcare, and HeartFlow outside the submitted work. All the other authors report no relationships relevant to the contents of this study to disclose. Publisher Copyright: {\textcopyright} 2021 ",

year = "2021",

month = dec,

day = "1",

doi = "10.1159/000517897",

language = "English",

volume = "146",

pages = "713--719",

journal = "Cardiology",

issn = "0008-6312",

publisher = "Karger",

number = "6",

}

TY - JOUR

T1 - Undetectable High-Sensitivity Troponin T as a Gatekeeper for Coronary Computed Tomography Angiography in Patients Suspected of Acute Coronary Syndrome

AU - Arslan, Murat

AU - Schaap, Jeroen

AU - Rood, Pleunie P.M.

AU - Nieman, Koen

AU - Budde, Ricardo P.J.

AU - Van Dalen, Bas M.

AU - Attrach, Mohamed

AU - Dubois, Eric A.

AU - Dedic, Admir

N1 - Funding Information: This work was supported by a grant from Erasmus MC and a research grant from the Erasmus MC Thorax Foundation (project grant B4). The sponsor had no role in study design; in the collection, analysis, and interpretation of data; in writing the report; and in the decision to submit the article for publication. Funding Information: Koen Nieman was supported by a grant from the Dutch Heart Foundation (NHS 2014T061) and received grants from Siemens Medical Solutions, GE Healthcare, Bayer Healthcare, and HeartFlow outside the submitted work. All the other authors report no relationships relevant to the contents of this study to disclose. Publisher Copyright: © 2021

PY - 2021/12/1

Y1 - 2021/12/1

N2 - Objectives: The aim of this study was to characterize the safety and efficiency of a strategy employing the limit of detection (LoD) of high-sensitivity troponin T (hs-TnT) as a gatekeeper for coronary computed tomography angiography (CCTA) in suspected acute coronary syndrome (ACS) patients in the emergency department (ED). Methods: We included suspected ACS patients who underwent CCTA and were evaluated with hs-TnT. Patients were categorized as below the LoD and at or above the LoD. The primary outcome was 30-day major adverse cardiac events (MACEs), defined as all-cause mortality, ACS, or coronary revascularization. Results: The study population consisted of 177 patients (mean age 55 ± 10 years, 50.3% women), and 16 (9.0%) patients reached the primary outcome. None of the patients died, while 13 had an adjudicated diagnosis of ACS, and 3 underwent elective coronary revascularization. There were 77 patients (44%) with an hs-TnT value below the LoD (MACEs; n = 1 [1.3%]) and 100 (56%) with at or above the LoD levels (MACEs; n = 15 [15%]). None of 67 patients with an hs-TnT value below the LoD and <50% stenosis on CCTA experienced MACEs. Out of the 10 patients with an hs-TnT value below the LoD and ≥50% stenosis on CCTA, 1 patient underwent elective percutaneous coronary revascularization. In patients with an hs-TnT value at or above the LoD, 74 patients had <50% stenosis on CCTA, and 2 patients (3%) were diagnosed with myocardial infarction without obstructive coronary artery disease confirmed on invasive angiography. Thirteen (50%) patients with an hs-TnT value at or above the LoD and ≥50% stenosis on CCTA experienced MACEs (11 ACS and 2 elective percutaneous coronary revascularizations). Conclusion: Our findings support that implementing the LoD of hs-TnT as a gatekeeper may reduce the need for CCTA in suspected ACS patients in the ED.

AB - Objectives: The aim of this study was to characterize the safety and efficiency of a strategy employing the limit of detection (LoD) of high-sensitivity troponin T (hs-TnT) as a gatekeeper for coronary computed tomography angiography (CCTA) in suspected acute coronary syndrome (ACS) patients in the emergency department (ED). Methods: We included suspected ACS patients who underwent CCTA and were evaluated with hs-TnT. Patients were categorized as below the LoD and at or above the LoD. The primary outcome was 30-day major adverse cardiac events (MACEs), defined as all-cause mortality, ACS, or coronary revascularization. Results: The study population consisted of 177 patients (mean age 55 ± 10 years, 50.3% women), and 16 (9.0%) patients reached the primary outcome. None of the patients died, while 13 had an adjudicated diagnosis of ACS, and 3 underwent elective coronary revascularization. There were 77 patients (44%) with an hs-TnT value below the LoD (MACEs; n = 1 [1.3%]) and 100 (56%) with at or above the LoD levels (MACEs; n = 15 [15%]). None of 67 patients with an hs-TnT value below the LoD and <50% stenosis on CCTA experienced MACEs. Out of the 10 patients with an hs-TnT value below the LoD and ≥50% stenosis on CCTA, 1 patient underwent elective percutaneous coronary revascularization. In patients with an hs-TnT value at or above the LoD, 74 patients had <50% stenosis on CCTA, and 2 patients (3%) were diagnosed with myocardial infarction without obstructive coronary artery disease confirmed on invasive angiography. Thirteen (50%) patients with an hs-TnT value at or above the LoD and ≥50% stenosis on CCTA experienced MACEs (11 ACS and 2 elective percutaneous coronary revascularizations). Conclusion: Our findings support that implementing the LoD of hs-TnT as a gatekeeper may reduce the need for CCTA in suspected ACS patients in the ED.

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U2 - 10.1159/000517897

DO - 10.1159/000517897

M3 - Article

C2 - 34148041

AN - SCOPUS:85120709467

SN - 0008-6312

VL - 146

SP - 713

EP - 719

JO - Cardiology

JF - Cardiology

IS - 6

ER -

Undetectable High-Sensitivity Troponin T as a Gatekeeper for Coronary Computed Tomography Angiography in Patients Suspected of Acute Coronary Syndrome

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