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Intravenous Statin Administration During Myocardial Infarction Compared With Oral Post-Infarct Administration Imaging Coronary Anatomy and Reducing Myocardial Infarction A Randomized Trial of a 1-Hour Troponin T Protocol in Suspected Acute Coronary Syndromes: The Rapid Assessment of Possible ACS In the Emergency Department with High Sensitivity Troponin T (RAPID-TnT) Study Dynamic Myocardial Ultrasound Localization Angiography Ticagrelor or Prasugrel in Patients with ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I Canadian SCAD Cohort Study: Shedding Light on SCAD From a United Front Considerations for Single-Measurement Risk-Stratification Strategies for Myocardial Infarction Using Cardiac Troponin Assays Homeostatic Chemokines and Prognosis in Patients With Acute Coronary Syndromes Morphine and Cardiovascular Outcomes Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Angiography
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EditorialAugust 25, 2018

JOURNAL：NEJM. Article Link

Imaging Coronary Anatomy and Reducing Myocardial Infarction

U Hoffmann, JE Udelson.

ABSTRACT

In 1998, the Journal published one of the early studies evaluating the sensitivity and specificity of coronary computed tomographic angiography (CTA), as compared with invasive coronary angiography, for the detection of obstructive coronary artery disease. Subsequent studies have established that CTA has excellent sensitivity (95 to 99%) and high specificity (64 to 83%) for the detection of coronary stenoses of 50% or greater. An analysis from the Prospective Multicenter Imaging Study for the Evaluation of Chest Pain (PROMISE) showed that CTA predicted subsequent cardiovascular events at least as well as, and perhaps better than, functional testing (C-statistic, 0.72 vs. 0.64; P=0.04). The National Institute for Health and Care Excellence of the United Kingdom now suggests that CTA is the most appropriate test in patients with stable chest pain in whom angina pectoris cannot be excluded by means of clinical assessment alone.

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