Most patients presenting to hospital with symptoms of a heart attack are sent home without further tests once a heart attack has been ruled out. Current strategies to assess patients with a suspected heart attack involve blood tests to measure troponin, a protein released into the bloodstream when the heart muscle is damaged. Despite having had a heart attack ruled-out, some patients have unrecognised heart disease and are at risk of having a heart attack in the future. However, clinicians do not know what is the best approach to identify and treat these patients. This study will use a heart scan known as computed tomography coronary angiogram (CTCA) to look for unrecognised heart disease in patients who have had a heart attack ruled out. In an earlier study, the Investigators performed this scan in patients referred to the outpatient cardiology clinic with stable chest pain and found that this improved the diagnosis of heart disease, leading to improvement in patient care that prevented future heart attacks. Previous research from the Investigators has also found that troponin levels below those used to diagnose a heart attack may help to identify those who are at greater risk of having a heart attack in the future. The aim of this study is to find out if patients with these low levels of troponin, where a heart attack has been ruled out, will benefit from CTCA to look for unrecognised coronary heart disease.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SCREENING
Masking
SINGLE
Enrollment
3,170
CTCA scan in accordance with British Society of Cardiovascular Imaging CT guidelines
NHS Lothian
Edinburgh, United Kingdom
NHS Greater Glasgow and Clyde
Glasgow, United Kingdom
Lewisham & Greenwich NHS Trust
London, United Kingdom
Milton Keynes University NHS Hospital
Milton Keynes, United Kingdom
University Hospitals Plymouth NHS Trust
Plymouth, United Kingdom
Royal Berkshire NHS Foundation Trust
Reading, United Kingdom
University Hospital Southampton NHS Trust
Southampton, United Kingdom
North Tees NHS Hospital Foundation
Stockton, United Kingdom
Torbay & South Devon NHS Foundation Trust
Torquay, United Kingdom
Composite of myocardial infarction or cardiac death
The first event of myocardial infarction or cardiac death
Time frame: Randomisation through to study completion, median duration of 36 months
Myocardial Infarction
The first event of myocardial infarction (MI). MI will be defined according to the 4th Universal Definition of Myocardial Infarction
Time frame: Randomisation through to study completion, median duration of 36 months
Cardiac death
Cardiac death will be defined as death resulting from an acute myocardial infarction, sudden cardiac death, or death due to heart failure.
Time frame: Randomisation through to study completion, median duration of 36 months
Cardiovascular death
Cardiovascular death will be defined as death resulting from an acute myocardial infarction, sudden cardiac death, death due to heart failure, death due to stroke, death due to cardiovascular haemorrhage, and death due to other cardiovascular causes
Time frame: Randomisation through to study completion, median duration of 36 months
Non-cardiovascular death
Time frame: Randomisation through to study completion, median duration of 36 months
All-cause death
Time frame: Randomisation through to study completion, median duration of 36 months
Unscheduled urgent coronary revascularisation
Unscheduled urgent coronary revascularisation will be identified via record linkage from central NHS registers (e.g. the Scottish Morbidity Register by the Information Services Division (ISD) Scotland) or from extracts obtained from the participating hospitals electronic patient record system.
Time frame: Randomisation through to study completion, median duration of 36 months
Hospital reattendance with suspected ACS
Reattendance with suspected ACS will be defined as any unscheduled hospital attendance where cardiac troponin testing is performed for suspected ACS following randomisation
Time frame: Randomisation through to study completion, median duration of 36 months
Proportion of patients with major bleeding (BARC 3-5)
Bleeding will be defined according to the Bleeding Academic Research Consortium (BARC) definition of bleeding. We will use pre-defined codes from International Classification of Diseases (ICD-10) and Office of Population Censuses and Surveys (OPCS) to classify each bleeding event as per the BARC definition.
Time frame: Randomisation through to study completion, median duration of 36 months
Symptomatic status as assessed by the short form Seattle Angina Questionnaire (SAQ-7)
Time frame: 3, 12 and 24 months
Quality of life as assessed by the EQ-5D-5L
Time frame: 3, 12 and 24 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.