Coronary Computed Tomographic Angiography in Intermediate-risk Chest Pain Patients (FAST-CCTA)
Chest Pain, Acute Coronary Syndrome, Coronary Artery Disease
About this trial
This is an interventional diagnostic trial for Chest Pain
Eligibility Criteria
Inclusion Criteria:
- Age≥18 years.
- Within 24 hours from presenting to the ED with chest pain or other symptoms suggestive of coronary artery disease (CAD)
- HEART-score >3 (according to http://www.heartscore.nl/)
- Written informed consent obtained
Exclusion Criteria:
- Any condition that may influence the patient's ability to comply with study protocol.
- Acute MI
- Known obstructive CAD (>50%) or previous PCI or CABG.
- Clear alternative diagnosis
- Estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73m2
- Major allergy to iodinated contrast media
- Circumstances making high quality images unlikely.
- Not a Swedish resident with a personal ID-number.
- Pregnancy or breast feeding
- Further investigation for CAD not indicated, due to limited life expectancy, quality of life or functional status
- Previous inclusion in the trial
Sites / Locations
- Danderyd HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Coronary computed tomopraphic angiography
No Coronary computed tomopraphic angiography
Patients randomized to strategy including early CCTA will receive standard care according to responsible physician and referred to a CCTA as soon as possible, preferably within 24 hours, but not later than within 7 days. Local scanning protocols can be used on ≥64-slice multi-detector CT scanners able to perform ECG-gated coronary angiography. The coronary angiography will be classified as normal (or near normal) or as having atherosclerosis (CAD). The report will also classify each vessel (left main, prox LAD, mid or distal LAD, LCX and RCA regarding degree of stenosis (no stenosis, 0-49%, ≥50%, or not possible to estimate because of calcification or technical reason). The result will be presented to the responsible physician as soon as possible and who will plan further care of the patients.
Patients randomized to a strategy not including early CCTA will receive further care (including examinations) according to responsible physician but not include early CCTA. These patients will often undergo a non-invasive functional test, such as Exercise-ECG, stress echocardiography or nuclear imaging according to local routines, but not always. Regardless of diagnostic strategy, the responsible physician is encouraged to initiate secondary prevention measures if the investigations indicate signs of CAD, including medication with aspirin and statins.