Early Coronary CT Angiography in Patients With Suspected or Provisionally Diagnosed Acute Coronary Syndrome - RAPID CTCA

Nov 16, 2020
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
National Institute for Health Research Health Technology Assessment
Date Presented:
11/16/2020
Date Updated:
11/16/2020
Original Posted Date:
11/16/2020
References

Contribution To Literature:

The RAPID CTCA trial failed to show that cardiac CT angiography was beneficial at improving outcomes in intermediate- and high-risk patients with chest pain.

Description:

The goal of the trial was to evaluate early cardiac computed tomography (CT) angiography compared with usual care among patients presented to the hospital with suspected or provisional acute coronary syndrome.

Study Design

  • Randomized
  • Parallel

Patients with suspected or provisional diagnosis of acute coronary syndrome were randomized to cardiac CT angiography (n = 877) versus usual care (n = 871).

  • Total number of enrollees: 1,748
  • Duration of follow-up: 1 year
  • Mean patient age: 62 years
  • Percentage female: 36%
  • Percentage with diabetes: 18%

Inclusion criteria:

Suspected or provisional diagnosis of acute coronary syndrome with at least one of the following:

  • Prior history of coronary heart disease
  • Troponin >99th percentile
  • Abnormal electrocardiogram

Other salient features/characteristics:

  • Imaging disclosed normal coronary arteries in 23%, nonobstructive disease in 29%, and obstructive disease in 47%
  • GRACE score: <109: 44%, 109-140: 32%, >140: 23%

Principal Findings:

The primary outcome of all-cause death or myocardial infarction (type 1, spontaneous) or (4b, stent thrombosis) at 1 year occurred in 5.8% of the cardiac CT angiography group compared with 6.1% of the usual care group (p = 0.65). This finding was the same in all tested subgroups.

Secondary outcomes:

  • Invasive coronary angiography for cardiac CT angiography group vs. usual care: adjusted hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.72-0.92
  • Coronary revascularization for cardiac CT angiography group vs. usual care: adjusted HR 1.03, 95% CI 0.87-1.21
  • Median length of hospitalization: 2.2 days for cardiac CT angiography vs. 2.0 days for usual care
  • Median health care costs: $9,494 for cardiac CT angiography vs. $8,776 for usual care

Interpretation:

Among patients presenting with suspected or provision acute coronary syndrome, cardiac CT angiography did not reduce the incidence of death or subsequent myocardial infarction. Cardiac CT angiography was associated with a modest increase in length of hospitalization and health care costs.

References:

Presented by Dr. Alastair J. Gray at the American Heart Association Virtual Scientific Sessions, November 16, 2020.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and ACS, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging

Keywords: AHA20, AHA Annual Scientific Sessions, Acute Coronary Syndrome, Chest Pain, Coronary Angiography, Coronary Disease, Diagnostic Imaging, Electrocardiography, Health Care Costs, Myocardial Infarction, Myocardial Revascularization, Stents, Thrombosis, Troponin, Tomography, X-Ray Computed


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