CT Coronary Angiogram Versus Traditional Care in Emergency Department Assessment of Potential ACS
Summary
This multi-center, randomized, controlled trial conducted in Emergency Departments (ED) compares computed tomography (CT) coronary angiography with the traditional approach (usual care) for low- to intermediate-risk chest pain patients. The primary objective is to estimate the rate of major cardiac events (heart attack or cardiac death) within 30 days in trial participants in Group B who were not found to have significant coronary artery disease by CT coronary angiography. Additional evaluations will comprise health care utilization assessments, including length of hospital stay and re-admissions, cost analysis, and 1-year post-triage/presentation major cardiac event rates.
Description
In this study, participants with potential ACS will be randomized to traditional "rule out" care (Group A) or to traditional care plus CT coronary angiography (Group B) in a ratio of 1:2 traditional versus traditional plus CT coronary angiography.
In Group A, all management and disposition decisions will be made by the healthcare providers caring for the participant. Participants will be admitted to hospital, admitted to cardiac diagnostic unit, or discharged to home. Diagnostic testing and treatment will be decided by the team caring for the participant. Follow up will comprise telephone interviews after 30 days and 1 year from triage/presentation.
In Group B, participants will receive initial cardiac troponin and creatinine blood tests. Upon return of normal laboratory values, the participants will receive a CT coronary angiography an estimated 90 minutes after the initial values assessment or as soon as the CT scanner is available. Participants with negative test results will be discharged; follow up will comprise telephone interviews after 30 days and 1 year from triage/presentation. Participants with positive test results will be admitted to the hospital for further management dictated by the admitting team.
Study Design
Allocation: Randomized, Endpoint Classification: Safety Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Diagnostic
Conditions
Chest Pain
Intervention
CT Coronary Angiography, Traditional, Standard of Care
Location
Wake Forest University Baptist Medical Center
Winston-Salem
North Carolina
United States
27157
Status
Active, not recruiting
Source
American College of Radiology Imaging Network
Results (where available)
Links
- Source: http://clinicaltrials.gov/show/NCT00933400
- Information obtained from ClinicalTrials.gov on April 11, 2012
Medical and Biotech [MESH] Definitions
Tietze's Syndrome
Idiopathic painful nonsuppurative swellings of one or more costal cartilages, especially of the second rib. The anterior chest pain may mimic that of coronary artery disease. (Dorland, 27th ed.)
Chest Pain
Pressure, burning, or numbness in the chest.
Coronary Angiography
Radiography of the vascular system of the heart muscle after injection of a contrast medium.
Acute Chest Syndrome
Respiratory syndrome characterized by the appearance of a new pulmonary infiltrate on chest x-ray, accompanied by symptoms of fever, cough, chest pain, tachypnea, or DYSPNEA, often seen in patients with SICKLE CELL ANEMIA. Multiple factors (e.g., infection, and pulmonary FAT EMBOLISM) may contribute to the development of the syndrome.
Coronary Aneurysm
Abnormal balloon- or sac-like dilatation in the wall of CORONARY VESSELS. Most coronary aneurysms are due to CORONARY ATHEROSCLEROSIS, and the rest are due to inflammatory diseases, such as KAWASAKI DISEASE.
Clinical Trials
Coronary CT Angiography in Acute Chest Pain is a Cost Effective Risk Stratification Strategy
This study will evaluate the impact of adding coronary computed tomographic angiography (CTA) on health care costs for diagnosing patients with acute chest pain.
Usefulness of CT Coronary Angiography to Evaluate ED Patients With Chest Pain
The purpose of this study is to evaluate whether 64-slice CT coronary angiography is useful for rapid diagnosis or exclusion of significant coronary artery disease in patients who present...
The purpose of this study is to determine whether Coronary Computed Tomographic Angiography (CCTA) will increase patient safety by decreasing the rate of missed ACS and adverse events in p...
Coronary Computed Tomography (CT) Angiography Versus Standard Therapy in the Emergency Room
The purpose of this study is to determine the usefulness of CCTA (Coronary CT Angiography) in the emergency room setting to diagnose and predict the outcome of patients with chest pain who...
Diagnostic Accuracy of Multislice CT Angiography for Acute Chest Pain
The ACUTE CT trial is designed to test whether the assessment of chest structures by high-resolution multislice computed tomography (CT) provides equivalent diagnostic accuracy for patient...
PubMed Articles
Evaluation of: Goldstein JA, Chinnaiyan KM, Abidov A et al. The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. J. Am. Coll....
The purpose of this study was to evaluate the performance of 320-row computed tomography angiography (CTA) in the identification of significant coronary artery disease (CAD) in patients presenting wit...
ABSTRACT: BACKGROUND: Coronary angiography is the current standard method to evaluate coronary atherosclerosis in patients with suspected angina pectoris, but non-invasive CT scanning of the coronarie...
Management Strategies for Patients with Low-Risk Chest Pain in the Emergency Department.
OPINION STATEMENT: There is abundant evidence to guide the management of chest pain patients with a confirmed or reasonably suspected diagnosis of acute coronary syndrome (ACS). But when it comes to t...
