Coronary computed tomography angiography in suspected acute coronary syndrome patients with intermediate high-sensitivity cardiac troponin I levels: a valuable diagnostic tool

Figures

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  Figure 1. Flow diagram. ACS, acute coronary syndrome; CABG, coronary artery bypass grafting; CCTA, coronary computed tomography angiography; ED, emergency department; hs-cTnI, high-sensitivity cardiac troponin I; PCI, percutaneous coronary intervention.

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  Figure 2. Observations within the CCTA group. CAD, coronary artery disease; CCTA, coronary computed tomography angiography.

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  Figure 3. Comparative analysis of primary outcomes between the CCTA group and the no-CCTA group. CCTA, coronary computed tomography angiography; ICA, invasive coronary angiography.

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  Figure 4. Cumulative MACEs rates in CCTA and no-CCTA groups. CCTA, coronary computed tomography angiography; CI, confidence interval; MACEs, major adverse cardiac events (including all-cause mortality, myocardial infarction, unplanned revascularization).

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  Figure 5. Cumulative MACEs rates in the CCTA and no-CCTA groups, stratified by CAD status-unknown (left) and known (right). CAD, coronary artery disease; CCTA, coronary computed tomography angiography; CI, confidence interval; MACEs, major adverse cardiac events (including all-cause mortality, myocardial infarction, unplanned revascularization).

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  Figure 6. Case presentation. A 59-year-old male patient presented with non-typical angina and a normal intermediate high-sensitivity cardiac troponin I concentration of 21 ng/L (the 99th percentile value being 34 ng/L). CCTA images shown the presence of calcified plaques (indicated by a white arrowhead) in the anterior descending artery (A); and the right coronary artery exhibited both calcified and mixed plaques (arrowhead), with a degree of stenosis approaching 50% (C). ICA performed within one week confirmed no significant stenosis in the anterior descending artery (B) and nearly 50% stenosis (arrowhead) in the right coronary artery (D), which was consistent with the findings from CCTA. CCTA, coronary computed tomography angiography; ICA, invasive coronary angiography.