Stanford University School of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA; Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Stanford University School of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA.
J Cardiovasc Comput Tomogr. 2019 Sep-Oct;13(5):267-273. doi: 10.1016/j.jcct.2019.05.007. Epub 2019 Jun 15.
Accurate and efficient diagnostic triage for acute chest pain (ACP) remains one of the most challenging problems in the emergency department (ED). While the proportion of patients that present with myocardial infarction (MI), aortic dissection, or pulmonary embolism is relatively low, a missed diagnosis can be life threatening. Coronary computed tomography angiography (CCTA) has developed into a robust diagnostic tool in the triage of ACP over the past decade, with several trials showing that it can reliably identify patients at low risk of major adverse cardiovascular events, shorten the length of stay in the ED, and reduce cost associated with the triage of patients with undifferentiated chest pain. Recently, however, high-sensitivity troponin assays have been increasingly incorporated as a rapid and efficient diagnostic test in the triage of ACP due to their higher sensitivity and negative predictive value of myocardial infarction. As more EDs adopt high-sensitivity troponin assays into routine clinical practice, the role of CCTA will likely change. In this review, we provide an overview of CCTA and high-sensitivity troponins for evaluation of patients with suspected ACS in the ED. Moreover, we discuss the changing role of CCTA in the era of high-sensitivity troponins.
准确、高效的急性胸痛（ACP）诊断分诊仍然是急诊科（ED）最具挑战性的问题之一。虽然心肌梗死（MI）、主动脉夹层或肺栓塞的患者比例相对较低，但漏诊可能会危及生命。在过去十年中，冠状动脉计算机断层扫描血管造影（CCTA）已成为 ACP 分诊的有力诊断工具，多项试验表明，它可以可靠地识别出低风险的主要不良心血管事件患者，缩短 ED 停留时间，并降低与未分化胸痛患者分诊相关的成本。然而，最近，由于高敏肌钙蛋白检测具有更高的心肌梗死灵敏度和阴性预测值，已越来越多地被纳入 ACP 的快速、高效诊断检测中。随着越来越多的 ED 将高敏肌钙蛋白检测纳入常规临床实践，CCTA 的作用可能会发生变化。在这篇综述中，我们将介绍 CCTA 和高敏肌钙蛋白在 ED 中评估疑似 ACS 患者的作用。此外，我们还讨论了在高敏肌钙蛋白时代 CCTA 作用的变化。
