Hs-troponin i followed by CT angiography improves acute coronary syndrome risk stratification accuracy and work-up in acute chest pain patients results from ROMICAT II trial

Maros Ferencik, Ting Liu, Thomas Mayrhofer, Stefan B. Puchner, Michael T. Lu, Pal Maurovich-Horvat, J. Hector Pope, Quynh A. Truong, James E. Udelson, W. Frank Peacock, Charles S. White, Pamela K. Woodard, Jerome L. Fleg, John T. Nagurney, James L. Januzzi, Udo Hoffmann

    Research output: Contribution to journalArticle

    26 Scopus citations

    Abstract

    Objectives This study compared diagnostic accuracy of conventional troponin/traditional coronary artery disease (CAD) assessment and highly sensitive troponin (hsTn) I/advanced CAD assessment for acute coronary syndrome (ACS) during the index hospitalization. Background hsTnI and advanced assessment of CAD using coronary computed tomography angiography (CTA) are promising candidates to improve the accuracy of emergency department evaluation of patients with suspected ACS. Methods We performed an observational cohort study in patients with suspected ACS enrolled in the ROMICAT II (Rule Out Myocardial Infarction/Ischemia using Computer Assisted Tomography) trial and randomized to coronary CTA who also had hsTnI measurement at the time of the emergency department presentation. We assessed coronary CTA for traditional (no CAD, nonobstructive CAD, ≥50% stenosis) and advanced features of CAD (≥50% stenosis, high-risk plaque features: positive remodeling, low <30-Hounsfield units plaque, napkin-ring sign, spotty calcium). Results Of 160 patients (mean age: 53 ± 8 years, 40% women) 10.6% were diagnosed with ACS. The ACS rate in patients with hsTnI below the limit of detection (n = 9, 5.6%), intermediate (n = 139, 86.9%), and above the 99th percentile (n = 12, 7.5%) was 0%, 8.6%, and 58.3%, respectively. Absence of ≥50% stenosis and high-risk plaque ruled out ACS in patients with intermediate hsTnI (n = 87, 54.4%; ACS rate 0%), whereas patients with both ≥50% stenosis and high-risk plaque were at high risk (n = 13, 8.1%; ACS rate 69.2%) and patients with either ≥50% stenosis or high-risk plaque were at intermediate risk for ACS (n = 39, 24.4%; ACS rate 7.7%). hsTnI/advanced coronary CTA assessment significantly improved the diagnostic accuracy for ACS as compared to conventional troponin/traditional coronary CTA (area under the curve 0.84, 95% confidence interval [CI]: 0.80 to.88 vs. 0.74, 95% CI: 0.70 to 0.78; p < 0.001). Conclusions hsTnI at the time of presentation followed by early advanced coronary CTA assessment improves the risk stratification and diagnostic accuracy for ACS as compared to conventional troponin and traditional coronary CTA assessment. (Multicenter Study to Rule Out Myocardial Infarction/Ischemia by Cardiac Computed Tomography [ROMICAT-II]; NCT01084239)

    Original languageEnglish (US)
    Pages (from-to)1272-1281
    Number of pages10
    JournalJACC: Cardiovascular Imaging
    Volume8
    Issue number11
    DOIs
    StatePublished - Nov 2015

    Keywords

    • acute coronary syndrome
    • coronary computed tomography angiography
    • coronary plaque
    • emergency department
    • highly sensitive troponin
    • risk stratification

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

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  • Cite this

    Ferencik, M., Liu, T., Mayrhofer, T., Puchner, S. B., Lu, M. T., Maurovich-Horvat, P., Pope, J. H., Truong, Q. A., Udelson, J. E., Peacock, W. F., White, C. S., Woodard, P. K., Fleg, J. L., Nagurney, J. T., Januzzi, J. L., & Hoffmann, U. (2015). Hs-troponin i followed by CT angiography improves acute coronary syndrome risk stratification accuracy and work-up in acute chest pain patients results from ROMICAT II trial. JACC: Cardiovascular Imaging, 8(11), 1272-1281. https://doi.org/10.1016/j.jcmg.2015.06.016