Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH)

Jesper James Linde; Klaus Fuglsang Kofoed; Mathias Sørgaard; Henning Kelbæk; Gorm Boje Jensen; Walter Bjørn Nielsen; Jens Dahlgaard Hove

doi:10.1016/j.ijcard.2013.08.020

Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH)

Jesper James Linde, Klaus Fuglsang Kofoed, Mathias Sørgaard, Henning Kelbæk, Gorm Boje Jensen, Walter Bjørn Nielsen, Jens Dahlgaard Hove

Department of Clinical Medicine

39 Citations (Scopus)

Abstract

Objectives In patients admitted on suspicion of acute coronary syndrome, with normal electrocardiogram and troponines, we evaluated the clinical impact of a Coronary CT angiography (CCTA)-strategy on referral rate for invasive coronary angiography (ICA), detection of significant coronary stenoses (positive predictive value [PPV]) and subsequent revascularisations, as compared to a function-based strategy (standard care). Secondarily we assessed intermediate term clinical events. Methods and results We randomised 600 patients to a CCTA-guided strategy (299 patients) or standard care (301 patients). In the CCTA-guided group referral for ICA required a coronary stenosis > 70% or > 50% in the left main, and for intermediate stenoses (50-70%), a stress test was used. A significant stenosis on ICA was defined as a stenosis ≥ 70% or reduced FFR ≤ 0.75 in intermediate stenoses (50-70%). Referral rate for ICA was 17% with CCTA vs. 12% with standard care (p = 0.1). ICA confirmed significant coronary artery stenoses in 12% vs. 4% (p = 0.001), and 10% vs. 4% were subsequently revascularised (p = 0.005). PPV for the detection of significant stenoses was 71% with CCTA vs 36% with standard care (p = 0.001). Clinical events (cardiac death, myocardial infarction, unstable angina pectoris, revascularisation and readmission for chest pain), during 120 days of follow-up, were recorded in 8 patients (3%) in the CCTA-guided group vs. 15 patients (5%) in the standard care group (p = 0.1). Conclusion In patients with recent acute-onset chest pain, a CCTA-guided diagnostic strategy improves PPV for the detection of significant coronary stenoses, and increases the frequency of revascularisations, when compared to a conventional functional approach.

Original language	English
Journal	International Journal of Cardiology
Volume	168
Issue number	6
Pages (from-to)	5257-5262
Number of pages	6
ISSN	0167-5273
DOIs	https://doi.org/10.1016/j.ijcard.2013.08.020
Publication status	Published - 15 Oct 2013

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Linde, J. J., Kofoed, K. F., Sørgaard, M., Kelbæk, H., Jensen, G. B., Nielsen, W. B., & Hove, J. D. (2013). Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH). International Journal of Cardiology, 168(6), 5257-5262. https://doi.org/10.1016/j.ijcard.2013.08.020

Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial : CArdiac cT in the treatment of acute CHest pain (CATCH). / Linde, Jesper James; Kofoed, Klaus Fuglsang; Sørgaard, Mathias et al.

In: International Journal of Cardiology, Vol. 168, No. 6, 15.10.2013, p. 5257-5262.

Research output: Contribution to journal › Journal article › Research › peer-review

Linde, JJ, Kofoed, KF, Sørgaard, M, Kelbæk, H, Jensen, GB, Nielsen, WB & Hove, JD 2013, 'Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH)', International Journal of Cardiology, vol. 168, no. 6, pp. 5257-5262. https://doi.org/10.1016/j.ijcard.2013.08.020

Linde JJ, Kofoed KF, Sørgaard M, Kelbæk H, Jensen GB, Nielsen WB et al. Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH). International Journal of Cardiology. 2013 Oct 15;168(6):5257-5262. doi: 10.1016/j.ijcard.2013.08.020

Linde, Jesper James ; Kofoed, Klaus Fuglsang ; Sørgaard, Mathias et al. / Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial : CArdiac cT in the treatment of acute CHest pain (CATCH). In: International Journal of Cardiology. 2013 ; Vol. 168, No. 6. pp. 5257-5262.

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title = "Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH)",

abstract = "Objectives In patients admitted on suspicion of acute coronary syndrome, with normal electrocardiogram and troponines, we evaluated the clinical impact of a Coronary CT angiography (CCTA)-strategy on referral rate for invasive coronary angiography (ICA), detection of significant coronary stenoses (positive predictive value [PPV]) and subsequent revascularisations, as compared to a function-based strategy (standard care). Secondarily we assessed intermediate term clinical events. Methods and results We randomised 600 patients to a CCTA-guided strategy (299 patients) or standard care (301 patients). In the CCTA-guided group referral for ICA required a coronary stenosis > 70% or > 50% in the left main, and for intermediate stenoses (50-70%), a stress test was used. A significant stenosis on ICA was defined as a stenosis ≥ 70% or reduced FFR ≤ 0.75 in intermediate stenoses (50-70%). Referral rate for ICA was 17% with CCTA vs. 12% with standard care (p = 0.1). ICA confirmed significant coronary artery stenoses in 12% vs. 4% (p = 0.001), and 10% vs. 4% were subsequently revascularised (p = 0.005). PPV for the detection of significant stenoses was 71% with CCTA vs 36% with standard care (p = 0.001). Clinical events (cardiac death, myocardial infarction, unstable angina pectoris, revascularisation and readmission for chest pain), during 120 days of follow-up, were recorded in 8 patients (3%) in the CCTA-guided group vs. 15 patients (5%) in the standard care group (p = 0.1). Conclusion In patients with recent acute-onset chest pain, a CCTA-guided diagnostic strategy improves PPV for the detection of significant coronary stenoses, and increases the frequency of revascularisations, when compared to a conventional functional approach.",

author = "Linde, {Jesper James} and Kofoed, {Klaus Fuglsang} and Mathias S{\o}rgaard and Henning Kelb{\ae}k and Jensen, {Gorm Boje} and Nielsen, {Walter Bj{\o}rn} and Hove, {Jens Dahlgaard}",

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doi = "10.1016/j.ijcard.2013.08.020",

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T1 - Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain ☆ ☆☆: Results from the randomised, controlled trial

T2 - CArdiac cT in the treatment of acute CHest pain (CATCH)

AU - Linde, Jesper James

AU - Kofoed, Klaus Fuglsang

AU - Sørgaard, Mathias

AU - Kelbæk, Henning

AU - Jensen, Gorm Boje

AU - Nielsen, Walter Bjørn

AU - Hove, Jens Dahlgaard

PY - 2013/10/15

Y1 - 2013/10/15

N2 - Objectives In patients admitted on suspicion of acute coronary syndrome, with normal electrocardiogram and troponines, we evaluated the clinical impact of a Coronary CT angiography (CCTA)-strategy on referral rate for invasive coronary angiography (ICA), detection of significant coronary stenoses (positive predictive value [PPV]) and subsequent revascularisations, as compared to a function-based strategy (standard care). Secondarily we assessed intermediate term clinical events. Methods and results We randomised 600 patients to a CCTA-guided strategy (299 patients) or standard care (301 patients). In the CCTA-guided group referral for ICA required a coronary stenosis > 70% or > 50% in the left main, and for intermediate stenoses (50-70%), a stress test was used. A significant stenosis on ICA was defined as a stenosis ≥ 70% or reduced FFR ≤ 0.75 in intermediate stenoses (50-70%). Referral rate for ICA was 17% with CCTA vs. 12% with standard care (p = 0.1). ICA confirmed significant coronary artery stenoses in 12% vs. 4% (p = 0.001), and 10% vs. 4% were subsequently revascularised (p = 0.005). PPV for the detection of significant stenoses was 71% with CCTA vs 36% with standard care (p = 0.001). Clinical events (cardiac death, myocardial infarction, unstable angina pectoris, revascularisation and readmission for chest pain), during 120 days of follow-up, were recorded in 8 patients (3%) in the CCTA-guided group vs. 15 patients (5%) in the standard care group (p = 0.1). Conclusion In patients with recent acute-onset chest pain, a CCTA-guided diagnostic strategy improves PPV for the detection of significant coronary stenoses, and increases the frequency of revascularisations, when compared to a conventional functional approach.

AB - Objectives In patients admitted on suspicion of acute coronary syndrome, with normal electrocardiogram and troponines, we evaluated the clinical impact of a Coronary CT angiography (CCTA)-strategy on referral rate for invasive coronary angiography (ICA), detection of significant coronary stenoses (positive predictive value [PPV]) and subsequent revascularisations, as compared to a function-based strategy (standard care). Secondarily we assessed intermediate term clinical events. Methods and results We randomised 600 patients to a CCTA-guided strategy (299 patients) or standard care (301 patients). In the CCTA-guided group referral for ICA required a coronary stenosis > 70% or > 50% in the left main, and for intermediate stenoses (50-70%), a stress test was used. A significant stenosis on ICA was defined as a stenosis ≥ 70% or reduced FFR ≤ 0.75 in intermediate stenoses (50-70%). Referral rate for ICA was 17% with CCTA vs. 12% with standard care (p = 0.1). ICA confirmed significant coronary artery stenoses in 12% vs. 4% (p = 0.001), and 10% vs. 4% were subsequently revascularised (p = 0.005). PPV for the detection of significant stenoses was 71% with CCTA vs 36% with standard care (p = 0.001). Clinical events (cardiac death, myocardial infarction, unstable angina pectoris, revascularisation and readmission for chest pain), during 120 days of follow-up, were recorded in 8 patients (3%) in the CCTA-guided group vs. 15 patients (5%) in the standard care group (p = 0.1). Conclusion In patients with recent acute-onset chest pain, a CCTA-guided diagnostic strategy improves PPV for the detection of significant coronary stenoses, and increases the frequency of revascularisations, when compared to a conventional functional approach.

U2 - 10.1016/j.ijcard.2013.08.020

DO - 10.1016/j.ijcard.2013.08.020

M3 - Journal article

C2 - 23998546

SN - 0167-5273

VL - 168

SP - 5257

EP - 5262

JO - International Journal of Cardiology

JF - International Journal of Cardiology

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