Early computed tomography coronary angiography and preventative treatment in patients with suspected acute coronary syndrome: A secondary analysis of the RAPID-CTCA trial.

Background: Computed tomography coronary angiography (CTCA) offers detailed assessment of the presence of coronary atherosclerosis and helps guide patient management. We investigated influences of early CTCA on the subsequent use of preventative treatment in patients with suspected acute coronary syndrome.
Methods: In this secondary analysis of a multicenter randomized controlled trial of early CTCA in intermediate-risk patients with suspected acute coronary syndrome, prescription of aspirin, P2Y ₁₂ receptor antagonist, statin, renin-angiotensin system blocker, and beta-blocker therapies from randomization to discharge were compared within then between those randomized to early CTCA or to standard of care only. Effects of CTCA findings on adjustment of these therapies were further examined.
Results: In 1,743 patients (874 randomized to early CTCA and 869 to standard of care only), prescription of P2Y ₁₂ receptor antagonist, dual antiplatelet, and statin therapies increased more in the early CTCA group (between-group difference: 4.6% [95% confidence interval, 0.3-8.9], 4.5% [95% confidence interval, 0.2-8.7], and 4.3% [95% confidence interval, 0.2-8.5], respectively), whereas prescription of other preventative therapies increased by similar extent in both study groups. Among patients randomized to early CTCA, there were additional increments of preventative treatment in those with obstructive coronary artery disease and higher rates of reductions in antiplatelet and beta-blocker therapies in those with normal coronary arteries.
Conclusions: Prescription patterns of preventative treatment varied during index hospitalization in patients with suspected acute coronary syndrome. Early CTCA facilitated targeted individualization of these therapies based on the extent of coronary artery disease.
Competing Interests: Disclosure We have no competing interests related to this manuscript to disclose. Katherine Oatey reports research grants from the British Heart Foundation, the Jon Moulton Charity Trust, and University of Edinburgh. Nick Curzen reports research grants from Beckman Coulter, Boston Scientific, HeartFlow, and Haemonetics; consulting fees and/or honoraria from Abbott, Boston Scientific, and Edwards Lifesciences; travel sponsorship from Abbott, Biosensors, and Edwards Lifesciences. Attila Kardos reports honoraria from the TomTec Imaging Systems. Liza Keating reports research grants from the Medical Research Council Developmental Pathway Funding Scheme and the Royal College of Emergency Medicine. Robert F Storey reports research grants from AstraZeneca, Cytosorbents, and GlyCardial Diagnostics; consulting fees and/or honoraria from Alfasigma, Alnylam Pharmaceuticals, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Chiesi, CSL Behring, Cytosorbents, Daiichi-Sankyo, GlyCardial Diagnostics, Hengrui, Idorsia, Intas Pharmaceuticals, Novartis, Pfizer, PhaseBio, Sanofi, and Thromboserin. Carl Roobottom reports honoraria from GE HealthCare.
(Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)