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Value of Myocardial Perfusion Assessment With Coronary Computed Tomography Angiography in Patients With Recent Acute-Onset Chest Pain
- Source :
- JACC: Cardiovascular Imaging. 11:1611-1621
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- The authors sought to perform a randomized controlled trial to evaluate the clinical efficacy of combined examination with coronary computed tomography angiography (CTA) and computed tomography perfusion imaging (CTP) compared to coronary CTA alone.Stress myocardial CTP may increase diagnostic specificity when added to coronary CTA in patients suspected of having ischemic heart disease.Patients recently hospitalized for acute-onset chest pain, who had acute coronary syndrome had been ruled out by normal electrocardiograms, normal troponin levels, and relief of symptoms, and who had a clinical indication for outpatient noninvasive testing, were screened for inclusion in the CATCH-2 (CArdiac cT in the treatment of acute CHest pain 2) trial (NCT02014311). Patients were randomized 1:1 to examination with coronary CTA or coronary CTA+CTP. The primary endpoint was the frequency of coronary revascularization among patients referred for invasive coronary angiography (ICA) based on index computed tomography evaluation. Secondary endpoints were invasive procedural complications at index-related ICA, post-index cardiac death, hospital admittance because of recurrence of chest pain, unstable angina pectoris, or acute myocardial infarction, ICA, and revascularization.Among 300 patients allocated to the coronary CTA+CTP group, 41 (14%) were referred for ICA compared with 89 (30%) allocated to coronary CTA (p 0.0001). The primary endpoint occurred in 50% of coronary CTA+CTP patients versus 48% of invasively examined patients (p = 0.85). The total number of revascularizations was significantly lower in the coronary CTA+CTP group compared to the coronary CTA group (n = 20 [7%] vs. n = 42 [14%]; p = 0.0045). At median follow-up of 1.5 years, the occurrence of secondary endpoints was similar in the 2 groups.A post-discharge diagnostic strategy of coronary CTA+CTP safely reduces the need for invasive examination and treatment in patients suspected of having ischemic heart disease. (CArdiac cT in the treatment of acute CHest pain 2-Myocardial CT Perfusion [CATCH2]; NCT02014311).
- Subjects :
- Male
Acute coronary syndrome
medicine.medical_specialty
Time Factors
Computed Tomography Angiography
Denmark
medicine.medical_treatment
Perfusion scanning
Coronary Artery Disease
030204 cardiovascular system & hematology
Coronary Angiography
Revascularization
Chest pain
Angina Pectoris
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Recurrence
Coronary Circulation
Internal medicine
Multidetector Computed Tomography
Myocardial Revascularization
medicine
Humans
Computed Tomography Perfusion Imaging
Radiology, Nuclear Medicine and imaging
Prospective Studies
cardiovascular diseases
Myocardial infarction
Aged
biology
Unstable angina
business.industry
Myocardial Perfusion Imaging
Reproducibility of Results
Middle Aged
medicine.disease
Troponin
Treatment Outcome
biology.protein
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 1936878X
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- JACC: Cardiovascular Imaging
- Accession number :
- edsair.doi.dedup.....6f0c50bf5707f3521863178014a885a5