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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.
Afiliación
  • Ratcovich H; Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark hanna.ratcovich@gmail.com.
  • Sadjadieh G; Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
  • Linde JJ; Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
  • Joshi FR; Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
  • Kelbæk H; Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark.
  • Kofoed KF; Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
  • Køber L; Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
  • Hansen PR; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
  • Torp-Pedersen C; Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerød, Denmark.
  • Elming H; Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark.
  • Gislason GH; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
  • Høfsten DE; Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
  • Engstrøm T; Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
  • Holmvang L; Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
Heart ; 109(6): 457-463, 2023 02 23.
Article en En | MEDLINE | ID: mdl-36351794
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Estenosis Coronaria / Síndrome Coronario Agudo Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Aged / Humans Idioma: En Revista: Heart Asunto de la revista: CARDIOLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Estenosis Coronaria / Síndrome Coronario Agudo Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Aged / Humans Idioma: En Revista: Heart Asunto de la revista: CARDIOLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Reino Unido