Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial

Kang Ling Wang; Carl Roobottom; Jason E. Smith; Steve Goodacre; Katherine Oatey; R O’Brien; Robert F. Storey; Nick Curzen; Liza Keating; Attila Kardos; Dirk Felmeden; Praveen Thokala; Nicholas L. Mills; David E. Newby; Alasdair J. Gray

doi:10.1093/ehjacc/zuac057

Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial

Kang Ling Wang^*, Carl Roobottom, Jason E. Smith, Steve Goodacre, Katherine Oatey, R O’Brien, Robert F. Storey, Nick Curzen, Liza Keating, Attila Kardos, Dirk Felmeden, Praveen Thokala, Nicholas L. Mills, David E. Newby, Alasdair J. Gray

^*Corresponding author for this work

Peninsula Medical School

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Abstract

Abstract Aims To evaluate the potential associations between presentation cardiac troponin and the clinical impact of early computed tomography coronary angiography (CTCA) in intermediate-risk patients with suspected acute coronary syndrome. Methods and results In a large multicentre randomized controlled trial of patients with intermediate-risk chest pain due to suspected acute coronary syndrome, early CTCA had no effect on the primary outcome—death or subsequent Type 1 or 4b myocardial infarction—but reduced the rate of invasive coronary angiography. In this pre-specified secondary analysis, cardiovascular testing and clinical outcomes were compared between those with or without cardiac troponin elevation at presentation. Of 1748 patients, 1004 (57%) had an elevated cardiac troponin concentration and 744 (43%) had a normal concentration. Patients with cardiac troponin elevation had a higher Global Registry of Acute Coronary Events score (132 vs. 91; P &lt; 0.001) and were more likely to have obstructive coronary artery disease (59 vs. 33%; P &lt; 0.001), non-invasive (72 vs. 52%; P &lt; 0.001) and invasive (72 vs. 38%; P &lt; 0.001) testing, coronary revascularization (47 vs. 15%; P &lt; 0.001), and the primary outcome (8 vs. 3%; P = 0.007) at 1 year. However, there was no evidence that presentation cardiac troponin was associated with the relative effects of early CTCA on rates of non-invasive (Pinteraction = 0.33) and invasive (Pinteraction = 0.99) testing, coronary revascularization (Pinteraction = 0.57), or the primary outcome (Pinteraction = 0.41). Conclusions Presentation cardiac troponin had no demonstrable associations between the effects of early CTCA on reductions in non-invasive and invasive testing, or the lack of effect on coronary revascularization or the primary outcome in intermediate-risk patients with suspected acute coronary syndrome.

Original language	English
Number of pages	0
Journal	European Heart Journal – Acute CardioVascular Care
Volume	0
Issue number	0
Early online date	1 Jun 2022
DOIs	https://doi.org/10.1093/ehjacc/zuac057
Publication status	Published - 1 Jun 2022

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Wang, K. L., Roobottom, C., Smith, J. E., Goodacre, S., Oatey, K., O’Brien, R., Storey, R. F., Curzen, N., Keating, L., Kardos, A., Felmeden, D., Thokala, P., Mills, N. L., Newby, D. E., & Gray, A. J. (2022). Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial. European Heart Journal – Acute CardioVascular Care, 0(0). https://doi.org/10.1093/ehjacc/zuac057

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title = "Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial",

abstract = "Abstract Aims To evaluate the potential associations between presentation cardiac troponin and the clinical impact of early computed tomography coronary angiography (CTCA) in intermediate-risk patients with suspected acute coronary syndrome. Methods and results In a large multicentre randomized controlled trial of patients with intermediate-risk chest pain due to suspected acute coronary syndrome, early CTCA had no effect on the primary outcome—death or subsequent Type 1 or 4b myocardial infarction—but reduced the rate of invasive coronary angiography. In this pre-specified secondary analysis, cardiovascular testing and clinical outcomes were compared between those with or without cardiac troponin elevation at presentation. Of 1748 patients, 1004 (57%) had an elevated cardiac troponin concentration and 744 (43%) had a normal concentration. Patients with cardiac troponin elevation had a higher Global Registry of Acute Coronary Events score (132 vs. 91; P < 0.001) and were more likely to have obstructive coronary artery disease (59 vs. 33%; P < 0.001), non-invasive (72 vs. 52%; P < 0.001) and invasive (72 vs. 38%; P < 0.001) testing, coronary revascularization (47 vs. 15%; P < 0.001), and the primary outcome (8 vs. 3%; P = 0.007) at 1 year. However, there was no evidence that presentation cardiac troponin was associated with the relative effects of early CTCA on rates of non-invasive (Pinteraction = 0.33) and invasive (Pinteraction = 0.99) testing, coronary revascularization (Pinteraction = 0.57), or the primary outcome (Pinteraction = 0.41). Conclusions Presentation cardiac troponin had no demonstrable associations between the effects of early CTCA on reductions in non-invasive and invasive testing, or the lack of effect on coronary revascularization or the primary outcome in intermediate-risk patients with suspected acute coronary syndrome. ",

author = "Wang, {Kang Ling} and Carl Roobottom and Smith, {Jason E.} and Steve Goodacre and Katherine Oatey and R O{\textquoteright}Brien and Storey, {Robert F.} and Nick Curzen and Liza Keating and Attila Kardos and Dirk Felmeden and Praveen Thokala and Mills, {Nicholas L.} and Newby, {David E.} and Gray, {Alasdair J.}",

year = "2022",

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day = "1",

doi = "10.1093/ehjacc/zuac057",

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Wang, KL, Roobottom, C, Smith, JE, Goodacre, S, Oatey, K, O’Brien, R, Storey, RF, Curzen, N, Keating, L, Kardos, A, Felmeden, D, Thokala, P, Mills, NL, Newby, DE & Gray, AJ 2022, 'Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial', European Heart Journal – Acute CardioVascular Care, vol. 0, no. 0. https://doi.org/10.1093/ehjacc/zuac057

Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial. / Wang, Kang Ling; Roobottom, Carl; Smith, Jason E. et al.
In: European Heart Journal – Acute CardioVascular Care, Vol. 0, No. 0, 01.06.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial

AU - Wang, Kang Ling

AU - Roobottom, Carl

AU - Smith, Jason E.

AU - Goodacre, Steve

AU - Oatey, Katherine

AU - O’Brien, R

AU - Storey, Robert F.

AU - Curzen, Nick

AU - Keating, Liza

AU - Kardos, Attila

AU - Felmeden, Dirk

AU - Thokala, Praveen

AU - Mills, Nicholas L.

AU - Newby, David E.

AU - Gray, Alasdair J.

PY - 2022/6/1

Y1 - 2022/6/1

N2 - Abstract Aims To evaluate the potential associations between presentation cardiac troponin and the clinical impact of early computed tomography coronary angiography (CTCA) in intermediate-risk patients with suspected acute coronary syndrome. Methods and results In a large multicentre randomized controlled trial of patients with intermediate-risk chest pain due to suspected acute coronary syndrome, early CTCA had no effect on the primary outcome—death or subsequent Type 1 or 4b myocardial infarction—but reduced the rate of invasive coronary angiography. In this pre-specified secondary analysis, cardiovascular testing and clinical outcomes were compared between those with or without cardiac troponin elevation at presentation. Of 1748 patients, 1004 (57%) had an elevated cardiac troponin concentration and 744 (43%) had a normal concentration. Patients with cardiac troponin elevation had a higher Global Registry of Acute Coronary Events score (132 vs. 91; P < 0.001) and were more likely to have obstructive coronary artery disease (59 vs. 33%; P < 0.001), non-invasive (72 vs. 52%; P < 0.001) and invasive (72 vs. 38%; P < 0.001) testing, coronary revascularization (47 vs. 15%; P < 0.001), and the primary outcome (8 vs. 3%; P = 0.007) at 1 year. However, there was no evidence that presentation cardiac troponin was associated with the relative effects of early CTCA on rates of non-invasive (Pinteraction = 0.33) and invasive (Pinteraction = 0.99) testing, coronary revascularization (Pinteraction = 0.57), or the primary outcome (Pinteraction = 0.41). Conclusions Presentation cardiac troponin had no demonstrable associations between the effects of early CTCA on reductions in non-invasive and invasive testing, or the lack of effect on coronary revascularization or the primary outcome in intermediate-risk patients with suspected acute coronary syndrome.

AB - Abstract Aims To evaluate the potential associations between presentation cardiac troponin and the clinical impact of early computed tomography coronary angiography (CTCA) in intermediate-risk patients with suspected acute coronary syndrome. Methods and results In a large multicentre randomized controlled trial of patients with intermediate-risk chest pain due to suspected acute coronary syndrome, early CTCA had no effect on the primary outcome—death or subsequent Type 1 or 4b myocardial infarction—but reduced the rate of invasive coronary angiography. In this pre-specified secondary analysis, cardiovascular testing and clinical outcomes were compared between those with or without cardiac troponin elevation at presentation. Of 1748 patients, 1004 (57%) had an elevated cardiac troponin concentration and 744 (43%) had a normal concentration. Patients with cardiac troponin elevation had a higher Global Registry of Acute Coronary Events score (132 vs. 91; P < 0.001) and were more likely to have obstructive coronary artery disease (59 vs. 33%; P < 0.001), non-invasive (72 vs. 52%; P < 0.001) and invasive (72 vs. 38%; P < 0.001) testing, coronary revascularization (47 vs. 15%; P < 0.001), and the primary outcome (8 vs. 3%; P = 0.007) at 1 year. However, there was no evidence that presentation cardiac troponin was associated with the relative effects of early CTCA on rates of non-invasive (Pinteraction = 0.33) and invasive (Pinteraction = 0.99) testing, coronary revascularization (Pinteraction = 0.57), or the primary outcome (Pinteraction = 0.41). Conclusions Presentation cardiac troponin had no demonstrable associations between the effects of early CTCA on reductions in non-invasive and invasive testing, or the lack of effect on coronary revascularization or the primary outcome in intermediate-risk patients with suspected acute coronary syndrome.

U2 - 10.1093/ehjacc/zuac057

DO - 10.1093/ehjacc/zuac057

M3 - Article

SN - 2048-8734

VL - 0

JO - European Heart Journal – Acute CardioVascular Care

JF - European Heart Journal – Acute CardioVascular Care

IS - 0

ER -

Wang KL, Roobottom C, Smith JE, Goodacre S, Oatey K, O’Brien R et al. Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial. European Heart Journal – Acute CardioVascular Care. 2022 Jun 1;0(0). Epub 2022 Jun 1. doi: 10.1093/ehjacc/zuac057

Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial

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