Better Evaluation of Acute Chest Pain With Computed Tomography Angiography

Erasmus Medical Center500 enrolled

Overview

The purpose of this study is to determine whether cardiac CT can improve triage of acute chest pain patients in the emergency department.

Myocardial infarction remains one of the most important causes of death and disability. Therefore it is important that individuals with acute chest pain are accurately assessed without delaying appropriate treatment. Acute coronary syndrome is only one cause for sudden chest pain, which is a very common complaint in the ER. Other life threatening causes such as pulmonary embolism and aortic dissection may also be the cause, although most chest discomfort has a benign reason (musculoskeletal, hyperventilation, oesophageal reflux, etc). The current work-up of suspected acute coronary syndrome, based on presentation, symptoms, ECG and biomarkers, is not efficient and results in unnecessary diagnostics and hospital admissions, as well as errors or delayed diagnoses, in a substantial number of patients. Computed tomography angiography (CTA) images atherosclerosis, coronary obstruction as well as myocardial hypoperfusion. We hypothesize that early use of CTA is of incremental value and allows for accurate and immediate triage of patients with acute chest pain.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

500

Conditions

Acute Coronary Syndrome Acute Chest Pain

Interventions

Cardiac CTRADIATION

Calcium scan and CT coronary angiography

Eligibility

Sex: ALLMin age: 30 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Acute chest pain or equivalent * Patients older than 30 years * Males \< 75 years and Females \< 80 years Exclusion Criteria: * STEMI * Troponin \> 0.1 * History of known myocardial infarction, PCI or CABG * Pregnancy * Contrast allergy * Renal disfunction * No informed consent possible * No follow-up possible

Locations (1)

Erasmus MC

Rotterdam, Netherlands

Outcomes

Primary Outcomes

Successful discharge rate

The proportion of patients discharged home without major adverse events during the following 30 days. Major adverse events are cardiovascular death or non-fatal myocardial infarction.

Time frame: 30 days

Diagnostic yield of invasive angiography

Number of patients identified with severe coronary artery disease identified by invasive angiography requiring revascularisation according to the international guidelines.

Time frame: 30 days

Secondary Outcomes

Successful discharge rate for all adverse events

The proportion of patients discharged home without any adverse events during the following 30 days. Adverse events are cardiovascular death, non-fatal myocardial infarction, unstable angina, coronary revascularization, repeat hospital visits for chest pain.

Time frame: 30 days

Major adverse events

Composite endpoint of major adverse cardiac events at 6 months: cardiovascular death, non-fatal myocardial infarction, unstable angina, coronary revascularisation and repeat hospital visits for chest pain.

Time frame: 6 months

Acute coronary syndrome

Diagnosis of acute coronary syndrome, according to international guidelines, at time of discharge.

Time frame: Index hospital visit

Missed myocardial infarctions

Missed myocardial infarctions, at 2-day follow-up, in patients discharged from the emergency department.

Time frame: 2 days

Duration of hospital stay

Data from ClinicalTrials.gov

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