Arq. Bras. Cardiol. 2022; 118(5): 903-904
Role of Computed Tomography in Excluding Acute Coronary Syndrome: is Anatomy the Way?
This Short Editorial is referred by the Research article "Diagnostic Performance of Coronary Tomography Angiography and Serial Measurements of Sensitive Cardiac Troponin in Patients With Chest Pain and Intermediate Risk for Cardiovascular Events".
Chest pain is one of the most common reasons for admission to the emergency room (ER). Although only a small minority of these correspond to an acute coronary syndrome (ACS), the potential severity of a misdiagnosis or a non-diagnosis implies using systematic protocols to confirm or exclude coronary artery disease (CAD) as a cause of symptoms. In recent years, the sequential blood testing of high-sensitive troponin (cTnI-hs) levels has become a safe and effective method in this context and is commonly applied worldwide. – However, this approach is associated with prolonged times in the ER and is not error-free, as some patients with unstable angina may not be correctly identified.
New approaches using imaging methods to exclude CAD gained relevance and have generated interest from the scientific community. Cardiac CT angiography (CTA), due to its high diagnostic performance, is assumed to be the main candidate to change the status-quo of the current approach based on serial blood testing. It is a simple, fast and robust test with a high negative predictive value – which makes it particularly suitable in ER, where it is essential to quickly and effectively exclude the presence of CAD. The ROMICAT studies were among the first to document the advantages of CTA in this context and to emphasize its additive prognostic value concerning the TIMI risk score (TIMI RS). However, like the vast majority of studies that used CTA in the context of hospital ER, their results mostly apply to low-risk populations. ,
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