Management of MI can be similar to stroke: Use CT angiogram. Don ' t depend only on STE on ECG for reperfusion?

This study suggests that it is possible with high accuracy (91% Negative Predictive Value) to exclude a ≥50% coronary stenosis by means of CTA (Computed Tomography Angiography). And indeed — it would be helpful in patients with NSTE-ACS to know that emergent cath is not needed because CTA was done in the ED and came back negative.According to the central illustration (above) — 88% (666/758 patients) of those with either a non-diagnostic or positive CTA result had significant coronary disease (presumably treated by reperfusion).Average time in this study to complete CTA evaluation was ~2.5 hours after the diagnosis of NSTE-ACS was made (1.8-4.2 hour range). This means the decision to perform CTA will entail some delay (probably at least 1-2 hours ...) in performing emergency cath if CTA results come back positive or equivocal. This needs to be factored into the decision-making process. I ’d argue that IF clinical history + the initial ECG suggest OMI (despite lack of ST elevation) — that time should not be lost ordering CTA, and then having to wait those couple of hours in the hope of getting a negative CTA result that would provide high likelihood ( =91% NPV) that there is no acute occlusion (albeit 91% is not 100%!).That said — CTA could prove very helpful in that group of NSTE-ACS patients in wh...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs