# Beeldvorming-geleide versus routinezorg bij NSTEMI: JACC

*geplaatst 2019-11-19 · Algemeen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2019.09.027 · https://hartvaat.nl/2019/11/19/beeldvorming-geleide-versus-routinezorg-bij-nstemi-jacc/*

Vergelijking van initiële beeldvorming-geleide strategie versus routinezorg bij NSTEMI.

## English: Initial Imaging-Guided Strategy Versus Routine Care in Patients With Non-ST-Segment Elevation Myocardial Infarction.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2019.09.027. Bijgewerkt 2026-07-03T13:27:27Z. 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.