- NEWS . 09 Nov 2020
CTA improves positive rate of ICA in low- to moderate-risk NSTEMI patients
A Chinese study was conducted recently to investigate whether computed tomography coronary angiography (CTA) can safely and effectively reduce the number of invasive coronary angiographies (ICAs) and increase the ICA-positive rate in patients with non-ST-segment elevation myocardial infarction (NSTEMI). These patients had a GRACE score of low or moderate risk.
A total of 102 NSTEMI patients (61 males and 41 females, aged 38–80 [58±12] years) were prospectively included and treated in Henan Provincial People's Hospital from February 2017 to February 2018. They were randomly assigned to the control group (n=51) and experimental group (n=51). Patients in the control group were risk stratified and arranged for elective ICA examination; if further intervention or surgical treatment was required, the ICA examination was positive. In the experimental group, the CTA examination was completed through the green channel first; if the CTA showed that the main coronary artery and its main branches had severe or extreme stenosis, further ICA examination was arranged; otherwise, a secondary prophylactic drug treatment was provided and the patients were then discharged and followed up for 1 year.
Results showed that the experimental group had a significantly higher positive rate of ICA compared with the control group (94.59% [35/37] vs 62.75% [32/51]; p<0.05), lower length of hospital stay (3.8±2.2 days vs 4.8±2.4 days), and lower Hospital Anxiety and Depression Score (8.8±4.5 vs 11.4±6.8). There were no significant differences in the cumulative incidence of major cardiovascular events (three vs five cases; p=0.423) and other serious adverse events (eight vs 10 cases; p=0.548) within 1 year between the two groups.
The study concluded that CTA significantly reduces the number of ICAs and the average length of hospital stay, and increases the positive rate of ICA in NSTEMI patients whose GRACE score is low or moderate risk. There is no increase in cardiovascular risks within 1 year.
Shen SX, et al. [The role of CT coronary angiography in improving the positive rate of coronary angiography in patients with low-or moderate-risk non-ST segment elevation myocardial infarction]. Zhonghua Yi Xue Za Zhi 2020;100:3255-3360.