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Sex-Specific Thresholds of High-Sensitivity Troponin in Patients With Suspected Acute Coronary Syndrome Pharmacoinvasive and Primary Percutaneous Coronary Intervention Strategies in ST-Elevation Myocardial Infarction (from the Mayo Clinic STEMI Network) 4-Step Protocol for Disparities in STEMI Care and Outcomes in Women Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial Impact of the US Food and Drug Administration–Approved Sex-Specific Cutoff Values for High-Sensitivity Cardiac Troponin T to Diagnose Myocardial Infarction Sex differences in discharge destination following acute myocardial infarction How Will the Transition to hs-cTn Affect the Diagnosis of Type 1 and 2 MI? Prevalence of anginal symptoms and myocardial ischemia and their effect on clinical outcomes in outpatients with stable coronary artery disease: data from the International Observational CLARIFY Registry 5-Year Prognostic Value of Quantitative Versus Visual MPI in Subtle Perfusion Defects: Results From REFINE SPECT
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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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