计算机断层扫描冠状动脉血管造影在急性胸痛中的靶向应用
完整摘要 · 中文译文
背景：许多因疑似急性冠脉综合征就诊于急诊科、但已排除心肌梗死的患者仍面临心血管事件风险。进一步检查是否能降低这一风险尚不清楚。 方法：在一项多中心、随机、对照试验中，英国14家医院急诊科就诊的患者若已排除心肌梗死且高敏心肌肌钙蛋白检测提示心血管事件风险为中等（高敏心肌肌钙蛋白I或T最高浓度＞5 ng/L），则纳入研究。参与者按1:1比例随机分配接受门诊计算机断层扫描（CT）冠状动脉造影指导的诊疗或标准诊疗。主要结局为心肌梗死或心源性死亡的复合终点。 结果：从2019年9月18日至2023年5月11日，共有3170名参与者（中位年龄61岁；女性占30.2%）被分配接受CT冠状动脉造影（1587名参与者）或接受标准治疗（1583名参与者）。随机分组后90天时，CT冠状动脉造影组中有1462名参与者（92.1%）接受了CT冠状动脉造影，标准治疗组中有35名参与者（2.2%）接受了CT冠状动脉造影。总体而言，7名参与者（0.4%）发生了CT冠状动脉造影相关不良事件。在中位3.0年后，此时标准治疗组的主要结局事件数超过了预先规定的最低值97，CT冠状动脉造影组中有112名参与者（7.1%）发生了主要结局事件，标准治疗组中有116名（7.3%）发生了主要结局事件（校正风险比，0.95；95%置信区间，0.73至1.23；P = 0.71）。 结论：在心肌梗死已被排除的疑似急性冠脉综合征患者中，常规CT冠状动脉造影指导的管理并未使后续心肌梗死或心源性死亡的发生率低于标准治疗。（由英国心脏基金会资助；TARGET-CTCA ClinicalTrials.gov注册号，NCT03952351。）。
完整摘要 · 英文原文
BACKGROUND: Many patients with suspected acute coronary syndrome in whom myocardial infarction has been ruled out in the emergency department remain at risk for cardiovascular events. Whether further investigation reduces this risk is unknown. METHODS: In a multicenter, randomized, controlled trial, patients who presented to an emergency department in 14 hospitals across the United Kingdom were enrolled if myocardial infarction had been ruled out and high-sensitivity cardiac troponin testing indicated an intermediate risk of a cardiovascular event (maximum high-sensitivity cardiac troponin I or T concentration, >5 ng per liter). Participants were randomly assigned in a 1:1 ratio to receive either outpatient computed tomographic (CT) coronary angiography-guided care or standard care. The primary outcome was a composite of myocardial infarction or death from a cardiac cause. RESULTS: From September 18, 2019, to May 11, 2023, a total of 3170 participants (median age, 61 years; female sex, 30.2%) were assigned to undergo CT coronary angiography (1587 participants) or receive standard care (1583 participants). At 90 days after randomization, CT coronary angiography had been performed in 1462 participants (92.1%) in the CT coronary angiography group and in 35 participants (2.2%) in the standard-care group. Overall, 7 participants (0.4%) had a CT coronary angiography-related adverse event. After a median of 3.0 years, at which point the number of primary-outcome events in the standard-care group exceeded the prespecified minimum of 97, a primary-outcome event had occurred in 112 participants (7.1%) in the CT coronary angiography group and in 116 (7.3%) in the standard-care group (adjusted hazard ratio, 0.95; 95% confidence interval, 0.73 to 1.23; P = 0.71). CONCLUSIONS: In patients with suspected acute coronary syndrome in whom myocardial infarction had been ruled out, routine CT coronary angiography-guided management did not result in a lower incidence of subsequent myocardial infarction or death from a cardiac cause than standard care. (Funded by the British Heart Foundation; TARGET-CTCA ClinicalTrials.gov number, NCT03952351.).