Role of Coronary CT Angiography in the Evaluation of Acute Chest Pain and Suspected or Confirmed Acute Coronary Syndrome

Advances in CT technology have resulted in improved imaging of the coronary anatomy in patients with stable coronary artery disease, using coronary CT angiography (CCTA). Recent data suggest that CCTA may play a role in higher risk patients, such as those evaluated in the emergency room with acute chest pain. Data thus far support the use of CCTA in low-risk patients with acute chest pain. Recent literature suggests that CCTA may play a role in the risk stratification of selected intermediate-risk patients. In this review, the authors discuss the emerging role of CCTA in higher risk patients, such as those with suspected or confirmed acute coronary syndrome (ACS). The excellent accuracy of CCTA in detecting obstructive coronary artery disease in patients with ACS is detailed, along with a highlighting of the safety of using CCTA in this setting. The authors also discuss the role for CCTA atheromatous plaque characterization, which is being increasingly recognized as an important predictor of clinical outcomes

Causes and Predictors of 30‐Day Readmission in Patients With COVID‐19 and ST‐Segment–Elevation Myocardial Infarction in the United States: A Nationwide Readmission Database Analysis

Background Rates, causes, and predictors of readmission in patients with ST‐segment–elevation myocardial infarction (STEMI) during COVID‐19 pandemic are unknown. Methods and Results All hospitalizations for STEMI were selected from the US Nationwide Readmissions Database 2020 and were stratified by the presence of COVID‐19. Primary outcome was 30‐day readmission. Multivariable hierarchical generalized logistic regression analysis was performed to compare 30‐day readmission between patients with STEMI with and without COVID‐19 and to identify the predictors of 30‐day readmissions in patients with STEMI and COVID‐19. The rate of 30‐day all‐cause readmission was 11.4% in patients with STEMI who had COVID‐19 and 10.6% in those without COVID‐19, with the adjusted odds ratio (OR) not being significantly different between the two groups (OR, 0.88 [95% CI, 0.73–1.07], P=0.200). Of all 30‐day readmissions in patients with STEMI and COVID‐19, 41% were for cardiac causes. Among the cardiac causes, 56% were secondary to acute coronary syndrome, while among the noncardiac causes, infections were the most prevalent. Among the causes of 30‐day readmissions, infectious causes were significantly higher for patients with STEMI who had COVID‐19 compared with those without COVID‐19 (29.9% versus 11.3%, P=0.001). In a multivariable model, congestive heart failure, chronic kidney disease, low median household income, and length of stay ≥5 days were found to be associated with an increased risk of 30‐day readmission. Conclusions Post‐STEMI, 30‐day readmission rates were similar between patients with and without COVID‐19. Cardiac causes were the most common causes for 30‐day readmissions, and infections were the most prevalent noncardiac causes