{"id":"e500327750a7","type":"article","url":"https://hartvaat.nl/2019/11/19/beeldvorming-geleide-versus-routinezorg-bij-nstemi-jacc/","title":"Beeldvorming-geleide versus routinezorg bij NSTEMI: JACC","title_en":"Initial Imaging-Guided Strategy Versus Routine Care in Patients With Non-ST-Segment Elevation Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.09.027","source_url":"https://doi.org/10.1016/j.jacc.2019.09.027","authors":["Martijn W Smulders","Bas L J H Kietselaer","Joachim E Wildberger","Pieter C Dagnelie","Hans-Peter Brunner-La Rocca","Alma M A Mingels","Yvonne J M van Cauteren","Ralph A L J Theunissen","Mark J Post","Simon Schalla","Sander M J van Kuijk","Marco Das","Raymond J Kim","Harry J G M Crijns","Sebastiaan C A M Bekkers"],"significance":6,"published":"2019-11-19","source_date":"2019-11-19","image":"","kennis":[],"congress":"","summary_en":"This study compared an initial imaging-guided strategy with routine invasive care in NSTEMI patients, testing whether non-invasive risk stratification can safely select patients for conservative management.","created":"2026-07-03T10:28:16Z","updated":"2026-07-03T13:27:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van initiële beeldvorming-geleide strategie versus routinezorg bij NSTEMI.","abstract_original":"BACKGROUND: Patients with non-ST-segment elevation myocardial infarction and elevated high-sensitivity cardiac troponin levels often routinely undergo invasive coronary angiography (ICA), but many do not have obstructive coronary artery disease. OBJECTIVES: This study investigated whether cardiovascular magnetic resonance imaging (CMR) or computed tomographic angiography (CTA) may serve as a safe gatekeeper for ICA. METHODS: This randomized controlled trial (NCT01559467) in 207 patients (age 64 years; 62% male patients) with acute chest pain, elevated high-sensitivity cardiac troponin T levels (>14 ng/l), and inconclusive electrocardiogram compared a CMR- or CTA-first strategy with a control strategy of routine clinical care. Follow-up ICA was recommended when initial CMR or CTA suggested myocardial ischemia, infarction, or obstructive coronary artery disease (≥70% stenosis). Primary efficacy and secondary safety endpoints were referral to ICA during hospitalization and 1-year outcomes (major adverse cardiac events and complications), respectively. RESULTS: The CMR- and CTA-first strategies reduced ICA compared with routine clinical care (87% [p = 0.001], 66% [p < 0.001], and 100%, respectively), with similar outcome (hazard ratio: CMR vs. routine, 0.78 [95% confidence interval: 0.37 to 1.61]; CTA vs. routine, 0.66 [95% confidence interval: 0.31 to 1.42]; and CMR vs. CTA, 1.19 [95% confidence interval: 0.53 to 2.66]). Obstructive coronary artery disease after ICA was found in 61% of patients in the routine clinical care arm, in 69% in the CMR-first arm (p = 0.308 vs. routine), and in 85% in the CTA-first arm (p = 0.006 vs. routine). In the non-CMR and non-CTA arms, follow-up CMR and CTA were performed in 67% and 13% of patients and led to a new diagnosis in 33% and 3%, respectively (p < 0.001). CONCLUSIONS: A novel strategy of implementing CMR or CTA first in the diagnostic process in non-ST-segment elevation myocardial infarction is a safe gatekeeper for ICA."}