Acute Coronary Syndrome, Acute Chest Pain
Conditions
Keywords
Acute coronary syndrome
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.
Interventions
RADIATIONCardiac CT
Calcium scan and CT coronary angiography
Sponsors
Erasmus Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
30 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Acute chest pain or equivalent * Patients older than 30 years * Males \< 75 years and Females \< 80 years
Exclusion criteria
* 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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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
| Measure | Time frame | Description |
|---|---|---|
| Acute coronary syndrome | Index hospital visit | Diagnosis of acute coronary syndrome, according to international guidelines, at time of discharge. |
| Missed myocardial infarctions | 2 days | Missed myocardial infarctions, at 2-day follow-up, in patients discharged from the emergency department. |
| Duration of hospital stay | Index hospital visit | Duration of hospital stay |
| 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. |
| Radiation exposure | 6 months | Cumulative medical radiation exposure at 6 months. |
| Renal function | 2 days | Change in renal function after 2 days. |
| Direct medical cost | 30 days | Direct medical costs until 30th day after ED visit. |
| 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. |
Countries
Netherlands
Outcome results
None listed