Building Coronary Lesion-Specific Predictive Models Using the Proper Prognostic Parameters

81.8% (95% CI: 72.2% to 89.2%), 68.0% (95% CI: 57.5% to 76.9%), and 97.3% (95% CI: 90.3% to 99.3%), and for the detection of obstructive CAD undergoing revascularization within 30 days, 100.0% (95% CI: 79.4% to 100.0%), 68.5% (95% CI: 58.9% to 77.1%), 32.0% (95% CI: 26.3% to 38.3%), and 100.0% (95% CI: 100.0% to 100.0%), respectively. This single-center experience revealed a good discriminatory capability of CTA to exclude obstructive CAD in approximately two-thirds of patients at intermediate to high risk, with a negative predictive value of 97% for ACS. Clinical factors and biomarkers were essential elements to safely exclude ACS and discharge. Although CTA is established for low-risk patients, CTA was used as an alternative strategy to standard care in intermediate-to-high-risk patients; therefore, we could expect that only a limited number of patients with this particular risk profile were triaged to CTA. We speculate that CTA may serve as a “gatekeeper” to ICA in patients at higher risk for ACS or inconclusive results. Although this sample showed promising results of a coronary CTA strategy in intermediate-to-high-risk ED patients, it is important to recognize that forthcoming randomized controlled data are necessary to inform care standards (3).