Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes

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Standard

Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes. / Ratcovich, Hanna; Sadjadieh, Golnaz; Linde, Jesper J.; Joshi, Francis R.; Kelbæk, Henning; Kofoed, Klaus F.; Køber, Lars; Hansen, Peter Riis; Torp-Pedersen, Christian; Elming, Hanne; Gislason, Gunnar Hilmar; Høfsten, Dan Eik; Engstrøm, Thomas; Holmvang, Lene.

I: Heart, Bind 109, Nr. 6, 2023, s. 457-463.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt

Harvard

Ratcovich, H, Sadjadieh, G, Linde, JJ, Joshi, FR, Kelbæk, H, Kofoed, KF, Køber, L, Hansen, PR, Torp-Pedersen, C, Elming, H, Gislason, GH, Høfsten, DE, Engstrøm, T & Holmvang, L 2023, 'Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes', Heart, bind 109, nr. 6, s. 457-463. https://doi.org/10.1136/heartjnl-2022-321640

APA

Ratcovich, H., Sadjadieh, G., Linde, J. J., Joshi, F. R., Kelbæk, H., Kofoed, K. F., Køber, L., Hansen, P. R., Torp-Pedersen, C., Elming, H., Gislason, G. H., Høfsten, D. E., Engstrøm, T., & Holmvang, L. (2023). Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes. Heart, 109(6), 457-463. https://doi.org/10.1136/heartjnl-2022-321640

Vancouver

Ratcovich H, Sadjadieh G, Linde JJ, Joshi FR, Kelbæk H, Kofoed KF o.a. Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes. Heart. 2023;109(6):457-463. https://doi.org/10.1136/heartjnl-2022-321640

Author

Ratcovich, Hanna ; Sadjadieh, Golnaz ; Linde, Jesper J. ; Joshi, Francis R. ; Kelbæk, Henning ; Kofoed, Klaus F. ; Køber, Lars ; Hansen, Peter Riis ; Torp-Pedersen, Christian ; Elming, Hanne ; Gislason, Gunnar Hilmar ; Høfsten, Dan Eik ; Engstrøm, Thomas ; Holmvang, Lene. / Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes. I: Heart. 2023 ; Bind 109, Nr. 6. s. 457-463.

Bibtex

@article{5454be3523294f9fbea4e64695b534fe,

title = "Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes",

abstract = "Background: The ability of coronary CT angiography (cCTA) to rule out significant coronary artery disease (CAD) in older patients with non-ST segment elevation acute coronary syndromes (NSTEACS) is unclear since valid cCTA analysis may be limited by extensive coronary artery calcification. In addition, the effect of very early invasive coronary angiography (ICA) with possible revascularisation is debated. Methods: This is a posthoc analysis of patients ≥75 years included in the Very Early vs Standard Care Invasive Examination and Treatment of Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Trial. cCTA was performed prior to the ICA. The diagnostic accuracy of cCTA was investigated. Presence of a coronary artery stenosis ≥50% by subsequent ICA was used as reference. Patients were randomised to a very early (within 12 hours of diagnosis) or a standard ICA (within 48-72 hours of diagnosis). The primary composite endpoint was 5-year all-cause mortality, non-fatal recurrent myocardial infarction or hospital admission for refractory myocardial ischaemia or heart failure. Results: Of 452 (21%) patients ≥75 years, 161 (35.6%) underwent cCTA. 19% of cCTAs excluded significant CAD. The negative predictive value (NPV) of cCTA was 94% (95% CI 79 to 99) and the sensitivity 98% (95% CI 94 to 100). No significant differences in the frequency of primary endpoints were seen in patients randomised to very early ICA (at 5-year follow-up, n=100 (46.9%) vs 122 (51.0%), log-rank p=0.357). Conclusion: In patients ≥75 years with NSTEACS, cCTA before ICA showed a high NPV. A very early ICA <12 hours of diagnosis did not significantly improve long-term clinical outcomes. ",

keywords = "acute coronary syndrome",

author = "Hanna Ratcovich and Golnaz Sadjadieh and Linde, {Jesper J.} and Joshi, {Francis R.} and Henning Kelb{\ae}k and Kofoed, {Klaus F.} and Lars K{\o}ber and Hansen, {Peter Riis} and Christian Torp-Pedersen and Hanne Elming and Gislason, {Gunnar Hilmar} and H{\o}fsten, {Dan Eik} and Thomas Engstr{\o}m and Lene Holmvang",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

doi = "10.1136/heartjnl-2022-321640",

language = "English",

volume = "109",

pages = "457--463",

journal = "Heart",

issn = "1355-6037",

publisher = "B M J Group",

number = "6",

}

RIS

TY - JOUR

T1 - Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes

AU - Ratcovich, Hanna

AU - Sadjadieh, Golnaz

AU - Linde, Jesper J.

AU - Joshi, Francis R.

AU - Kelbæk, Henning

AU - Kofoed, Klaus F.

AU - Køber, Lars

AU - Hansen, Peter Riis

AU - Torp-Pedersen, Christian

AU - Elming, Hanne

AU - Gislason, Gunnar Hilmar

AU - Høfsten, Dan Eik

AU - Engstrøm, Thomas

AU - Holmvang, Lene

PY - 2023

Y1 - 2023

N2 - Background: The ability of coronary CT angiography (cCTA) to rule out significant coronary artery disease (CAD) in older patients with non-ST segment elevation acute coronary syndromes (NSTEACS) is unclear since valid cCTA analysis may be limited by extensive coronary artery calcification. In addition, the effect of very early invasive coronary angiography (ICA) with possible revascularisation is debated. Methods: This is a posthoc analysis of patients ≥75 years included in the Very Early vs Standard Care Invasive Examination and Treatment of Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Trial. cCTA was performed prior to the ICA. The diagnostic accuracy of cCTA was investigated. Presence of a coronary artery stenosis ≥50% by subsequent ICA was used as reference. Patients were randomised to a very early (within 12 hours of diagnosis) or a standard ICA (within 48-72 hours of diagnosis). The primary composite endpoint was 5-year all-cause mortality, non-fatal recurrent myocardial infarction or hospital admission for refractory myocardial ischaemia or heart failure. Results: Of 452 (21%) patients ≥75 years, 161 (35.6%) underwent cCTA. 19% of cCTAs excluded significant CAD. The negative predictive value (NPV) of cCTA was 94% (95% CI 79 to 99) and the sensitivity 98% (95% CI 94 to 100). No significant differences in the frequency of primary endpoints were seen in patients randomised to very early ICA (at 5-year follow-up, n=100 (46.9%) vs 122 (51.0%), log-rank p=0.357). Conclusion: In patients ≥75 years with NSTEACS, cCTA before ICA showed a high NPV. A very early ICA <12 hours of diagnosis did not significantly improve long-term clinical outcomes.

AB - Background: The ability of coronary CT angiography (cCTA) to rule out significant coronary artery disease (CAD) in older patients with non-ST segment elevation acute coronary syndromes (NSTEACS) is unclear since valid cCTA analysis may be limited by extensive coronary artery calcification. In addition, the effect of very early invasive coronary angiography (ICA) with possible revascularisation is debated. Methods: This is a posthoc analysis of patients ≥75 years included in the Very Early vs Standard Care Invasive Examination and Treatment of Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Trial. cCTA was performed prior to the ICA. The diagnostic accuracy of cCTA was investigated. Presence of a coronary artery stenosis ≥50% by subsequent ICA was used as reference. Patients were randomised to a very early (within 12 hours of diagnosis) or a standard ICA (within 48-72 hours of diagnosis). The primary composite endpoint was 5-year all-cause mortality, non-fatal recurrent myocardial infarction or hospital admission for refractory myocardial ischaemia or heart failure. Results: Of 452 (21%) patients ≥75 years, 161 (35.6%) underwent cCTA. 19% of cCTAs excluded significant CAD. The negative predictive value (NPV) of cCTA was 94% (95% CI 79 to 99) and the sensitivity 98% (95% CI 94 to 100). No significant differences in the frequency of primary endpoints were seen in patients randomised to very early ICA (at 5-year follow-up, n=100 (46.9%) vs 122 (51.0%), log-rank p=0.357). Conclusion: In patients ≥75 years with NSTEACS, cCTA before ICA showed a high NPV. A very early ICA <12 hours of diagnosis did not significantly improve long-term clinical outcomes.

KW - acute coronary syndrome

U2 - 10.1136/heartjnl-2022-321640

DO - 10.1136/heartjnl-2022-321640

M3 - Journal article

C2 - 36351794

AN - SCOPUS:85143502809

VL - 109

SP - 457

EP - 463

JO - Heart

JF - Heart

SN - 1355-6037

IS - 6

ER -

ID: 338359944