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EBM verdict
General medicine
Consider a CT angiogram before invasive coronary angiogram in patients with NSTEMI
  1. Jack O'Sullivan1,2
  1. 1 Division of Cardiology, Department of Medicine, Stanford University, Stanford, California, USA
  2. 2 Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Dr Jack O'Sullivan, Stanford University, Stanford, CA 94305, USA; jackos{at}stanford.edu

https://doi.org/10.1136/bmjebm-2020-111402

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    Patients with non-ST-elevation myocardial infarction (NSTEMI) may have coronary artery disease requiring revascularisation. However, many patients with NSTEMI do not. CT angiogram appears to be an effective way to stratify these patients.

    Patients with non-ST-elevation myocardial infarction (NSTEMI) present a challenging clinical conundrum.1 Some of these patients have severe coronary artery disease requiring urgent revascularisation, while others have such little coronary stenosis that no revascularisation nor antithrombotic treatment is, ultimately, required. The difficulty facing clinicians is how they can identify those who need urgent revascularisation.

    The conventional answer to this has been to offer all of these patients, in time, invasive coronary angiograms. However, these procedures are resource intensive and carry non-insignificant risks for patients.2 Furthermore, conventional practice has been to prioritise patients with ST-elevation myocardial infarction, often resulting in patients with NSTEMI to be given prolonged (often days) antithrombotic and anticoagulation treatment while they await their diagnostic angiogram. These treatments increase one’s risk of bleeding and, in the absence of coronary stenosis, >50% provide no benefit.2 In an effort to better identify patients with NSTEMI who do truly require coronary angiogram and revascularisation, Danish investigators conducted an observational, …

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    Footnotes

    • Twitter @DrJackOSullivan

    • Contributors JOS is the sole author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.