TY - JOUR T1 - Clinical decision aids and computed tomography coronary angiography in patients with suspected acute coronary syndrome. AU - Wang,Kang-Ling, AU - Taggart,Caelan, AU - McDermott,Michael, AU - O'Brien,Rachel, AU - Oatey,Katherine, AU - Keating,Liza, AU - Storey,Robert F, AU - Felmeden,Dirk, AU - Curzen,Nick, AU - Kardos,Attila, AU - Roobottom,Carl, AU - Smith,Jason, AU - Goodacre,Steve, AU - Newby,David E, AU - Gray,Alasdair J, AU - ,, Y1 - 2024/07/22/ PY - 2024/01/11/received PY - 2024/05/16/accepted PY - 2024/7/23/medline PY - 2024/6/11/pubmed PY - 2024/6/10/entrez KW - clinical SP - 488 EP - 494 JF - Emergency medicine journal : EMJ JO - Emerg Med J VL - 41 IS - 8 N2 - BACKGROUND: The HEART score, the T-MACS model and the GRACE score support early decision-making for acute chest pain, which could be complemented by CT coronary angiography (CTCA). However, their performance has not been directly compared. METHODS: In this secondary analysis of a multicentre randomised controlled trial of early CTCA in intermediate-risk patients with suspected acute coronary syndrome, C-statistics and performance metrics (using the predefined cut-offs) of clinical decision aids and CTCA, alone and then in combination, for the index hospital diagnosis of acute coronary syndrome and for 30-day coronary revascularisation were assessed in those who underwent CTCA and had complete data. RESULTS: Among 699 patients, 358 (51%) had an index hospital diagnosis of acute coronary syndrome, for which the C-statistic was higher for CTCA (0.80), followed by the T-MACS model (0.78), the HEART score (0.74) and the GRACE score (0.60). The negative predictive value was higher for the absence of coronary artery disease on CTCA (0.90) or a T-MACS estimate of <0.05 (0.83) than a HEART score of <4 (0.81) and a GRACE score of <109 (0.55). For 30-day coronary revascularisation, CTCA had the greatest C-statistic (0.80) with a negative predictive value of 0.96 and 0.92 in the absence of coronary artery disease and obstructive coronary artery disease, respectively. The combination of the T-MACS estimates and the CTCA findings was most discriminative for the index hospital diagnosis of acute coronary syndrome (C-statistic, 0.88) and predictive of 30-day coronary revascularisation (C-statistic, 0.85). No patients with a T-MACS estimate of <0.05 and normal coronary arteries had acute coronary syndrome during index hospitalisation or underwent coronary revascularisation within 30 days. CONCLUSIONS: In intermediate-risk patients with suspected acute coronary syndrome, the T-MACS model combined with CTCA improved discrimination of the index hospital diagnosis of acute coronary syndrome and prediction of 30-day coronary revascularisation. TRIAL REGISTRATION NUMBER: NCT02284191. SN - 1472-0213 UR - https://www.unboundmedicine.com/medline/citation/38857986/ DB - PRIME DP - Unbound Medicine ER -