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Revascularization Strategies in STEMI with Multivessel Disease: Deciding on Culprit Versus Complete-Ad Hoc or Staged Eruptive Calcified Nodules as a Potential Mechanism of Acute Coronary Thrombosis and Sudden Death Prevalence of Angina Among Primary Care Patients With Coronary Artery Disease Homeostatic Chemokines and Prognosis in Patients With Acute Coronary Syndromes Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With STEMI: A Cardiac Magnetic Resonance Study Acute Myocardial Injury in Patients Hospitalized With COVID-19 Infection: A Review Considerations for Single-Measurement Risk-Stratification Strategies for Myocardial Infarction Using Cardiac Troponin Assays Invasive Versus Medical Management in Patients With Prior Coronary Artery Bypass Surgery With a Non-ST Segment Elevation Acute Coronary Syndrome: A Pilot Randomized Controlled Trial Association of Thrombus Aspiration With Time and Mortality Among Patients With ST-Segment Elevation Myocardial Infarction: A Post Hoc Analysis of the Randomized TOTAL Trial Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction
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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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