van Cauteren Yvonne J M, Lemmens Marie-Julie D K, Bekkers Sebastiaan C A M, Kietselaer Bas L J H, Heijman Jordi, Theunissen Ralph A L J, Rahel Braim, Voorn Talitha, van Kuijk Sander M J, Nijveldt Robin, Vernooy Kevin, Wildberger Joachim E, Mihl Casper, Smulders Martijn W
Department of Cardiology, Maastricht UMC+, Maastricht, Netherlands (the).
Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, Netherlands (the).
Int J Cardiol Heart Vasc. 2025 May 2;59:101690. doi: 10.1016/j.ijcha.2025.101690. eCollection 2025 Aug.
Approximately one-third of patients with suspected non-ST-elevation myocardial infarction (NSTEMI) have non-obstructive coronary artery disease. Low-risk patients might benefit from early non-invasive diagnostic testing that can appropriately select those without obstructive coronary artery disease and prevent unnecessary invasive coronary angiography (ICA). The purpose of this study is to evaluate the diagnostic value of computed tomography angiography (CTA) in suspected NSTEMI.
Patients with clinically suspected type 1 NSTEMI were included. In case ICA was indicated, CTA was performed prior to ICA. The accuracy of CTA to diagnose NSTEMI, assigned by an adjudicated final diagnosis committee, was investigated.
Of the 66 included patients, 40 (61%) were diagnosed with NSTEMI. CAD-RADS ≥ 3 (i.e. stenosis ≥50%) had a sensitivity of 95% (95%CI 83-99%), a specificity of 65% (95%CI 44-83%) and an overall accuracy of 83% (95%CI 72-91%). The Agatston score was significantly different between patients with and without NSTEMI (404 [IQR 132-883] and 31 [IQR 0-163], respectively, p < 0.001). Nineteen patients (29%) met the criteria of ≥2 high-risk plaque (HRP) features, which was more often present in patients with NSTEMI compared to those without NSTEMI (43% and 8%, respectively, p = 0.002). Combining all CTA parameters (CAD-RADS ≥ 3, Agatston score >1.000 and ≥2 HRP features) did not improve the diagnostic accuracy compared with CAD-RADS alone.
CTA accurately diagnoses NSTEMI in patients with acute chest pain and elevated high-sensitivity cardiac troponin T levels. Patients with NSTEMI more often presented with CAD-RADS ≥ 3, Agatston score >1.000 and HRP features.
约三分之一疑似非ST段抬高型心肌梗死（NSTEMI）患者患有非阻塞性冠状动脉疾病。低风险患者可能受益于早期非侵入性诊断测试，该测试可以适当筛选出无阻塞性冠状动脉疾病的患者，并避免不必要的侵入性冠状动脉造影（ICA）。本研究的目的是评估计算机断层扫描血管造影（CTA）在疑似NSTEMI中的诊断价值。
纳入临床疑似1型NSTEMI患者。若需进行ICA，则在ICA之前先进行CTA。研究由一个判定最终诊断委员会指定的CTA诊断NSTEMI的准确性。
66例纳入患者中，40例（61%）被诊断为NSTEMI。CAD-RADS≥3（即狭窄≥50%）的敏感性为95%（95%CI 83-99%），特异性为65%（95%CI 44-83%），总体准确性为83%（95%CI 72-91%）。有和无NSTEMI患者的阿加斯顿评分有显著差异（分别为404[四分位间距132-883]和31[四分位间距0-163]，p<0.001）。19例患者（29%）符合≥2个高危斑块（HRP）特征标准，与无NSTEMI患者相比，NSTEMI患者中更常出现该情况（分别为43%和8%，p=0.002）。与单独使用CAD-RADS相比，综合所有CTA参数（CAD-RADS≥3、阿加斯顿评分>1000和≥2个HRP特征）并未提高诊断准确性。
CTA能准确诊断急性胸痛且高敏心肌肌钙蛋白T水平升高患者的NSTEMI。NSTEMI患者更常出现CAD-RADS≥3、阿加斯顿评分>1000和HRP特征。
