{
  "abstract": "Introduction There are no established standardized guidelines for acceptable coronary CT angiogram (CTCA) in type II myocardial infarction(MI) patient populations although CT coronary angiogram is regarded as the first-line investigation for stable angina with intermediate pre-test probability of coronary artery disease(CAD). 1 A lack of standardized non-invasive pathway in patients with type II MI has led to unnecessary waiting lists for invasive coronary angiogram and potentially unavoidable risks of complications following invasive procedures.Purpose A standardized coronary CT angiogram(CTCA) pathway was devised for patients with suspected type II myocardial infarction(MI) that are indicated per European Cardiology guidelines. 2 Further objectives were to understand the diagnostic accuracy of CTCA and to formulate local guidelines to standardize non-invasive screening pathway for this patient population.Methods A total of 80 patients were listed for in-patient invasive coronary angiogram with the suspicion of obstructive coronary artery disease from 1st September 2024 to 1st February 2025. Out of these 50 were met criteria for potential diagnosis of type II myocardial infarction as indicated by 2018 European Cardiology Myocardial Infarction Guideline. 1 A standardized coronary CT angiogram (CTCA) clinical pathway was devised for our study population and diagnostic findings were assessed in three domains, which comprises the degree of coronary calcifications using calcium scores, the burden of plaque using coronary flow analysis , and other non-cardiac findings.Results All patients identified (n=50) had been diagnosed with type II myocardial infarction (MI). Patients with ST-segment elevated infarction(STEMI) were excluded. Mean age was 77.2 years (range 46–102).Of the 50 patients, it was found that only 20 out of 50 (40%) reported as flow-limiting coronary artery disease(CAD) with revascularization target. Those participants were known to have intermediate or high cardiovascular risk profile such as smoking, diabetes, hypertension, etc. In 30 (60%) of the 50 patients, 20 were reported as non-flow limiting coronary artery disease with mild to moderate calcified plaque burden, and additional non-cardiac findings were reported as the primary cause of chest pain. The remaining 10 out of 30 patients were classified as normal coronary artery and normal calcium score on their reported CT findings. Overall, the role of diagnostic CT coronary angiogram in type II myocardial infarction has been proven to reveal primary medical cause on top of coronary artery calcification and to estimate the plaque burden with accurate target of revascularization based on the coronary flow analysis.Conclusion The incorporation of standardized CT coronary angiogram in type II myocardial infarction has led to significant improvement in patient quality of care and potential reduction in risk of unavoidable risks of complications following invasive angiogram. However, future primary research is warranted for its diagnostic accuracy in wider population such as microvascular dysfunction, or angina with no obstructed coronary artery disease(ANOCA subgroup).References Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio AL, Crea F, Goudevenos JA, Halvorsen S, Hindricks G. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018 Jan 7;39(2):119–177.Fyyaz S, Olabintan O, David S, Plein S, Alfakih K. ESC guidelines on stable chest pain: a comparison of the previous and current risk scores for the assessment of pre-test probability of coronary artery disease. European Heart Journal. 2020 Nov;41(Supplement_2):ehaa946–1371.",
  "authors": [
    {
      "affiliations": [
        "University Hospital Plymouth, Plymouth, UK"
      ],
      "name": "Khin Kay Kay Kyaw"
    },
    {
      "affiliations": [
        "University Hospital Plymouth, Plymouth, UK"
      ],
      "name": "Vivek Rathore"
    }
  ],
  "title": "7-023 Standardized Coronary CT angiogram improves risk prevention and diagnostic accuracy for type II myocardial infarction (MI) patient population in a tertiary care centre",
  "uid": "818ee35d-bfd2-53eb-a5c8-78b9e25a4098"
}