Comparison of CT Coronary Artery Calcium Scoring With Traditional Assessment in Patients Presenting to the Rapid Access Chest Pain Clinic With Non-acute Chest Pain and Its Prognostic Value
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 705
- 试验地点
- 1
- 主要终点
- All-cause mortality
研究概览
简要总结
Patients with stable chest pain presenting to general practitioners in UK are routinely referred to the chest pain clinics in the hospitals. They are assessed by clinical history including risk factors, cardiovascular exam, resting ECG, chest x-ray, and exercise ECG. CT calcium scoring (CTCS) is a technique that is very sensitive in identifying and quantifying calcified atherosclerotic plaques. Recent guidance from the National Institute of Clinical Excellence (NICE, citation 1) proposes the use of CTCS in patients with stable chest pain who have low likelihood of coronary artery disease (CAD). They recommend that patients with low likelihood (10-30%) have a CTCS and if the score is 0, they can be considered to have non-cardiac chest pain. However, there is controversy regarding relationship of absent calcification with significant CAD and its prognostic value.
At our institution, we have been performing CTCS in this patient cohort since 2003. We plan to retrospectively review the usefulness in CTCS in patients with different likelihood for significant CAD, particularly in patients with absent calcium and compare with the traditional assessment. We also plan to follow-up these patients for any myocardial infarction and death from any cause.
详细描述
The study seeks to determine the usefulness of CT calcium scoring (CTCS) in patients presenting with non-acute chest pain to the rapid access chest pain clinic (RACPC) and compare it with the traditional assessment in predicting significant CAD and outcome with respect to non-fatal MI or death. The clinical, diagnostic, and follow-up data of patients in last 7 years since CTCS has been performed in the hospital would be retrospectively analysed for the purpose.
Background Patients with chest pain (excluding that of sudden onset) are routinely referred by the GPs to the RACPC centres in the hospitals. They are assessed by clinical history including risk factors, cardiovascular exam, resting ECG, chest x-ray, and exercise ECG. At our institution, we have also been performing CTCS in men more than 40 and women more than 50 years of age since 2003. Recent NICE guidance1 recommends that patients with low pre-test probability (10-30%) of significant coronary artery disease (CAD) have a CT calcium scoring scan and if the score is 0, they can be considered to have non-cardiac chest pain. However, there is controversy regarding relationship of absent calcification with significant CAD and its prognostic value.
This study would enable us to compare and determine the value of CTCS in patients with non-acute chest pain in predicting significant CAD and safety of absent coronary artery calcification.
Rationale for Study
- To determine if CT coronary calcium scoring adds any value to the existing clinical assessment and exercise ECG. This is not well established in patients presenting with non-acute chest pain to the rapid access chest pain clinics.
- The study would help in determining if absence of calcification on CT can be considered to have low likelihood of significant coronary artery disease and a good cardiovascular outcome over the period of follow-up. Both these issues are currently controversial in the literature in this group of patients.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 40 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •non-acute chest pain
- •those who underwent CT calcium scoring
- •availability of all relevant risk factor information
排除标准
- •previous coronary disease i.e., myocardial infarction or revascularization
结局指标
主要结局
All-cause mortality
时间窗: 7 years
次要结局
- Non-fatal myocardial infarction(7 years)