Acute Coronary Syndrome, Non-ST-Elevation Myocardial Infarction, Unstable Angina
Conditions
Keywords
ACS, Unstable Angina, NSTEMI
Brief summary
The purpose of this project is to examine the effectiveness of computed tomographic angiography (CTA) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). People who are hospitalized with this situation often require an angiogram to assess the heart and its arteries. Recent advancements in technology have enabled CTA to clearly define coronary artery anatomy with great accuracy and to guide treatment strategies in select patient populations. We are investigating that CTA may be used, as an alternative to conventional angiograms, for the risk stratification of patients with high risk NSTE-ACS. Patients eligible for the study will be high risk NSTE-ACS and awaiting an angiogram. Enrolled patients will undergo CTA prior to the angiogram. With each CTA the patient will be injected with a small dose of an X-ray dye and will be asked to lie still on the scanning bed for a period of 5-10 minutes.
Interventions
PROCEDUREComputed Tomographic Angiography
CT scan
Sponsors
Ottawa Heart Institute Research Corporation
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* High risk ACS 1. Angina \[accelerating pattern or prolonged episode (\> 20 minutes) or recurrent episode at rest or with minimal effort within preceding 24 hours\]; and (13) 2. Elevated Troponin - T (≥0.1 ug/L) or ECG changes consistent with ischemia \[ST depression ≥ 0.1 mV, transient ST segment elevation ≥ 0.1 mV (\< 20 minutes)\]) (11;13) * Planned conventional invasive coronary angiography
Exclusion criteria
* Age \< 18 years or lack of consent * Renal Insufficiency (GFR \< 60 ml/min) * Allergy to contrast agent * Refractory angina requiring urgent/emergent coronary angiography (as per treating physician) * Contraindication to radiation exposure (e.g. pregnancy) * Uncontrolled HR * Previous CABG or PCI/Stent * Atrial fibrillation, frequent atrial or ventricular ectopy (\> 1 / minute) * Unable to perform 20 second breath-hold
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Operating Characteristics of CTA | 1 month |
Secondary
| Measure | Time frame |
|---|---|
| To compare the accuracy of CTA to CICA in predicting the mode of revascularization (PCI versus CABG) in NSTE-ACS patients. | 1 month |
| To determine the number of avoidable CICA (i.e. those accurately designated to medical therapy or surgery with CTA). | 1 month |
Countries
Canada
Outcome results
None listed