Early CTCA in patients with suspected ACS: RCT – results

By AJ Gray et al
Taken directly from BMJ 

In intermediate risk patients with acute chest pain and suspected acute coronary syndrome, early CT coronary angiography did not alter overall coronary therapeutic interventions or one year clinical outcomes, but reduced rates of invasive angiography while modestly increasing length of hospital stay. These findings do not support the routine use of early CT coronary angiography in intermediate risk patients with acute chest pain and suspected acute coronary syndrome.

Adults with suspected or a provisional diagnosis of acute coronary syndrome and one or more of previous coronary heart disease, raised levels of cardiac troponin, or abnormal electrocardiogram were included in this study across 37 hospitals in the UK. Early CTCA + standard care was compared with standard care only.

Primary endpoint was all cause death or subsequent type 1 or 4b myocardial infarction at one year.

Between 23 March 2015 and 27 June 2019, 1748 participants with mean age of 62 years, 64% men, mean GRACE score 115 were randomised to receive early CT coronary angiography (n=877) or standard of care only (n=871). 

Median time from randomisation to CTCA was 4.2 hours. The primary endpoint occurred in 51 (5.8%) participants randomised to CT coronary angiography and 53 (6.1%) participants who received standard care only (adjusted hazard ratio 0.91 (95% confidence interval 0.62 to 1.35), P=0.65). Invasive coronary angiography was performed in 474 (54.0%) participants randomised to CT coronary angiography and 530 (60.8%) participants who received standard care.

There were no overall differences in coronary revascularisation, use of drug treatment for acute coronary syndrome, or subsequent preventive treatments between the two groups. Early CTCA coronary angiography was associated with a slightly longer time in hospital (median increase 0.21 days from a median hospital stay of 2.0 to 2.2 days.

Read full articlehttps://www.bmj.com/content/374/bmj.n2106

Gray AJ, Roobottom C, Smith JE, Goodacre S, Oatey K, O’Brien R, Storey RF, Curzen N, Keating L, Kardos A, Felmeden D, Lee RJ, Thokala P, Lewis SC, Newby DE; RAPID-CTCA Investigators. Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial. BMJ. 2021 Sep 29;374:n2106. doi: 10.1136/bmj.n2106. PMID: 34588162.