Better Evaluation of Acute Chest Pain With Computed Tomography Angiography
- Conditions
- Acute Coronary SyndromeAcute Chest Pain
- Interventions
- Radiation: Cardiac CT
- Registration Number
- NCT01413282
- Lead Sponsor
- Erasmus Medical Center
- Brief Summary
The purpose of this study is to determine whether cardiac CT can improve triage of acute chest pain patients in the emergency department.
- Detailed Description
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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 500
- Acute chest pain or equivalent
- Patients older than 30 years
- Males < 75 years and Females < 80 years
- 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
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Cardiac CT Cardiac CT Triage based on cardiac CT results.
- Primary Outcome Measures
Name Time Method Successful discharge rate 30 days 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.
Diagnostic yield of invasive angiography 30 days Number of patients identified with severe coronary artery disease identified by invasive angiography requiring revascularisation according to the international guidelines.
- Secondary Outcome Measures
Name Time Method Successful discharge rate for all adverse events 30 days 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.
Major adverse events 6 months 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.
Duration of hospital stay Index hospital visit Duration of hospital stay
Direct medical cost 30 days Direct medical costs until 30th day after ED visit.
Missed myocardial infarctions 2 days Missed myocardial infarctions, at 2-day follow-up, in patients discharged from the emergency department.
Radiation exposure 6 months Cumulative medical radiation exposure at 6 months.
Acute coronary syndrome Index hospital visit Diagnosis of acute coronary syndrome, according to international guidelines, at time of discharge.
Renal function 2 days Change in renal function after 2 days.
Trial Locations
- Locations (1)
Erasmus MC
🇳🇱Rotterdam, Netherlands