Ruling Out Coronary Artery Disease and Myocardial Injury by Biomarkers
Ruling Out Coronary Artery Disease and Myocardial Injury by Biomarkers
A considerable proportion of patients with clinically suspected coronary artery disease (CAD)
 do not have angiographic signs of luminal narrowing caused by coronary atherosclerosis. In
 patients with suspected CAD, we will assess the ability of cardiovascular biomarkers to
 identify patients with (a) angiographically normal epicardial coronary vessels (b) absence of
 significant epicardial coronary stenosis, as assessed by coronary computed tomography
 angiography (CCTA). Patients will be stratified according to the presence or absence of
 dynamic changes of high sensitivity cardiac troponin T levels above the 99th percentile.
This is an observational study of patients with suspected coronary artery disease referred to
 coronary computed tomography angiography (CCTA). The plan is to include 1000 patients prior
 to CCTA at two centers.

 Blood samples for biomarker measurement will be obtained prior to the procedures. The
 diagnostic results of the imaging tests will be compared to the levels of circulating
 troponins. Patient will be followed for a minimum of 12 months and the incidence of
 cardiovascular death, all-cause mortality, acute coronary syndromes, revascularization, heart
 failure, stroke and cardiac arrhythmias requiring rehospitalization. Symptoms of angina
 pectoris according to the Canadian Cardiovascular Society grading of angina pectoris and
 symptoms of chronic heart failure according to the New York Heart Association classification
 of chronic heart failure will be recorded.
Inclusion Criteria:

 -  Consenting patient over the age of 18 referred to CCTA for suspected coronary artery
 disease

 Exclusion Criteria:

 -  Inability to provide informed consent.

 -  Short life expectancy (<12 months) due to non-cardiovascular disease