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<p>Suspected acute coronary syndrome (ACS) is one of the most common reasons for urgent cardiology evaluation in the emergency department (ED). This study aimed to evaluate the characteristics and outcomes of patients with suspected ACS who were referred for coronary computed tomography angiography (CCTA) in the ED. We retrospectively enrolled consecutive patients who underwent cardiology assessment and CCTA for suspected ACS in the ED from January 2020 through December 2022. The primary endpoint was a composite of major adverse cardiovascular events (MACE) including all-cause death, acute myocardial infarction, or myocardial revascularization. The study included 198 patients, of whom 175 (51% male) had available follow-up data. Elevated high-sensitivity cardiac troponin I (hs-cTnI) was detected in 42% of patients. Compared to those with normal hs-cTnI, patients with elevated hs-cTnI showed a higher prevalence of atrial fibrillation (12% vs 1%; p &lt; 0.001), paroxysmal supraventricular tachycardia (10% vs 0%; p &lt; 0.001), and pericardial effusion (10% vs 2%; p = 0.023), and were more frequently referred for cardiovascular magnetic resonance (19% vs 4%; p &lt; 0.001). Over a median follow-up of 28&#xa0;months (IQR:18–34), 14 patients (8%) reached the composite endpoint. After adjusting for demographics, ECG data, and hs-cTnI levels, obstructive atherosclerosis in left main (aHR = 18.31, p = 0.004), circumflex (Cx) (aHR = 8.54, p = 0.008), right coronary artery (aHR = 5.22, p = 0.028), moderate atherosclerosis in the left anterior descending artery (aHR = 6.88, p = 0.039) and mild irregularities in the Cx (aHR = 5.86, p = 0.043) were associated with a higher incidence of MACE. Both the presence of high-risk plaque and higher CAD-RADS 2.0 categories were associated with an increased likelihood of in-hospital revascularization and a survival tree model incorporating myocardial injury markers and CCTA findings demonstrated potential utility for risk stratification. In patients with suspected ACS undergoing cardiology assessment in the ED, CCTA may support patient management.</p> Graphical abstract <p>AF: atrial fibrillation; CAD: coronary artery disease; CCTA: coronary computed tomography angiography; CMR: cardiovascular magnetic resonance; DAPT: dual antiplatelet therapy; ED: emergency department; LAD: left anterior descending artery; SVT: supraventricular tachycardia</p> <p></p>

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Characteristics and outcomes of patients undergoing coronary computed tomography angiography for suspected acute coronary syndrome in the emergency department

  • 期刊论文

  • 发表日期：

    2026年7月4日

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  • Giuseppe Ciliberti,
  • Paolo Compagnucci,
  • Luca Finori,
  • Marco Fogante,
  • Michela Casella,
  • Edoardo Conte,
  • Federico Fortuni,
  • Adelina Selimi,
  • Nicolò Schicchi,
  • Roberto Manfredi,
  • Alice Frangione,
  • Paolo Esposto Pirani,
  • Giacomo Agliata,
  • Samuele Principi,
  • Maria Chiara Basile,
  • Matteo Marcosignori,
  • Giulio Argalia,
  • Tobias Stephan Augustin Schnitzler,
  • Giovanni Calogerà,
  • Luca Bergamaschi,
  • Matteo Oliva,
  • Gustavo Cirese,
  • Marco Marini,
  • Annalisa Mattioli,
  • Matteo Armillotta,
  • Silvano Molini,
  • Tommaso Piva,
  • Marco Gigli,
  • Monica Verdoia,
  • Carmine Pizzi,
  • Fabrizio Ricci,
  • Susanna Contucci,
  • Andrea Giovagnoni,
  • Federico Guerra,
  • Antonio Dello Russo

摘要

Suspected acute coronary syndrome (ACS) is one of the most common reasons for urgent cardiology evaluation in the emergency department (ED). This study aimed to evaluate the characteristics and outcomes of patients with suspected ACS who were referred for coronary computed tomography angiography (CCTA) in the ED. We retrospectively enrolled consecutive patients who underwent cardiology assessment and CCTA for suspected ACS in the ED from January 2020 through December 2022. The primary endpoint was a composite of major adverse cardiovascular events (MACE) including all-cause death, acute myocardial infarction, or myocardial revascularization. The study included 198 patients, of whom 175 (51% male) had available follow-up data. Elevated high-sensitivity cardiac troponin I (hs-cTnI) was detected in 42% of patients. Compared to those with normal hs-cTnI, patients with elevated hs-cTnI showed a higher prevalence of atrial fibrillation (12% vs 1%; p < 0.001), paroxysmal supraventricular tachycardia (10% vs 0%; p < 0.001), and pericardial effusion (10% vs 2%; p = 0.023), and were more frequently referred for cardiovascular magnetic resonance (19% vs 4%; p < 0.001). Over a median follow-up of 28 months (IQR:18–34), 14 patients (8%) reached the composite endpoint. After adjusting for demographics, ECG data, and hs-cTnI levels, obstructive atherosclerosis in left main (aHR = 18.31, p = 0.004), circumflex (Cx) (aHR = 8.54, p = 0.008), right coronary artery (aHR = 5.22, p = 0.028), moderate atherosclerosis in the left anterior descending artery (aHR = 6.88, p = 0.039) and mild irregularities in the Cx (aHR = 5.86, p = 0.043) were associated with a higher incidence of MACE. Both the presence of high-risk plaque and higher CAD-RADS 2.0 categories were associated with an increased likelihood of in-hospital revascularization and a survival tree model incorporating myocardial injury markers and CCTA findings demonstrated potential utility for risk stratification. In patients with suspected ACS undergoing cardiology assessment in the ED, CCTA may support patient management.

Graphical abstract

AF: atrial fibrillation; CAD: coronary artery disease; CCTA: coronary computed tomography angiography; CMR: cardiovascular magnetic resonance; DAPT: dual antiplatelet therapy; ED: emergency department; LAD: left anterior descending artery; SVT: supraventricular tachycardia