Jesper J Linde1, Jens D Hove2, Mathias Sørgaard3, Henning Kelbæk4, Gorm B Jensen5, Jørgen T Kühl3, Louise Hindsø3, Lars Køber3, Walter B Nielsen5, Klaus F Kofoed6. 1. Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark; Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: jesper_linde@hotmail.com. 2. Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark; Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark. 3. Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 4. Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark. 5. Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark. 6. Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Abstract
OBJECTIVES: The aim of the CATCH (CArdiac cT in the treatment of acute CHest pain) trial was to investigate the long-term clinical impact of a coronary computed tomographic angiography (CTA)-guided treatment strategy in patients with recent acute-onset chest pain compared to standard care. BACKGROUND: The prognostic implications of a coronary CTA-guided treatment strategy have not been compared in a randomized fashion to standard care in patients referred for acute-onset chest pain. METHODS:Patients with acute chest pain but normal electrocardiograms and troponin values were randomized to treatment guided by either coronary CTA or standard care (bicycle exercise electrocardiogram or myocardial perfusion imaging). In the coronary CTA-guided group, a functional test was included in cases of nondiagnostic coronary CTA images or coronary stenoses of borderline severity. The primary endpoint was a composite of cardiac death, myocardial infarction (MI), hospitalization for unstable angina pectoris (UAP), late symptom-driven revascularizations, and readmission for chest pain. RESULTS: We randomized 299 patients to coronary CTA-guided strategy and 301 to standard care. After inclusion, 24 patients withdrew their consent. The median (interquartile range) follow-up duration was 18.7 (range 16.8 to 20.1) months. In the coronary CTA-guided group, 30 patients (11%) had a primary endpoint versus 47 patients (16%) in the standard care group (p = 0.04; hazard ratio [HR]: 0.62 [95% confidence interval: 0.40 to 0.98]). A major adverse cardiac event (cardiac death, MI, hospitalization for UAP, and late symptom-driven revascularization) was observed in 5 patients (2 MIs, 3 UAPs) in the coronary CTA-guided group versus 14 patients (1 cardiac death, 7 MIs, 5 UAPs, 1 late symptom-driven revascularization) in the standard care group (p = 0.04; HR: 0.36 [95% CI: 0.16 to 0.95]). Differences in cardiac death and MI (8 vs. 2) were insignificant (p = 0.06). CONCLUSIONS: A coronary CTA-guided treatment strategy appears to improve clinical outcome in patients with recent acute-onset chest pain and normal electrocardiograms and troponin values compared to standard care with a functional test. (Cardiac-CT in the Treatment of Acute Chest Pain [CATCH]; NCT01534000).
RCT Entities:
OBJECTIVES: The aim of the CATCH (CArdiac cT in the treatment of acute CHest pain) trial was to investigate the long-term clinical impact of a coronary computed tomographic angiography (CTA)-guided treatment strategy in patients with recent acute-onset chest pain compared to standard care. BACKGROUND: The prognostic implications of a coronary CTA-guided treatment strategy have not been compared in a randomized fashion to standard care in patients referred for acute-onset chest pain. METHODS:Patients with acute chest pain but normal electrocardiograms and troponin values were randomized to treatment guided by either coronary CTA or standard care (bicycle exercise electrocardiogram or myocardial perfusion imaging). In the coronary CTA-guided group, a functional test was included in cases of nondiagnostic coronary CTA images or coronary stenoses of borderline severity. The primary endpoint was a composite of cardiac death, myocardial infarction (MI), hospitalization for unstable angina pectoris (UAP), late symptom-driven revascularizations, and readmission for chest pain. RESULTS: We randomized 299 patients to coronary CTA-guided strategy and 301 to standard care. After inclusion, 24 patients withdrew their consent. The median (interquartile range) follow-up duration was 18.7 (range 16.8 to 20.1) months. In the coronary CTA-guided group, 30 patients (11%) had a primary endpoint versus 47 patients (16%) in the standard care group (p = 0.04; hazard ratio [HR]: 0.62 [95% confidence interval: 0.40 to 0.98]). A major adverse cardiac event (cardiac death, MI, hospitalization for UAP, and late symptom-driven revascularization) was observed in 5 patients (2 MIs, 3 UAPs) in the coronary CTA-guided group versus 14 patients (1 cardiac death, 7 MIs, 5 UAPs, 1 late symptom-driven revascularization) in the standard care group (p = 0.04; HR: 0.36 [95% CI: 0.16 to 0.95]). Differences in cardiac death and MI (8 vs. 2) were insignificant (p = 0.06). CONCLUSIONS: A coronary CTA-guided treatment strategy appears to improve clinical outcome in patients with recent acute-onset chest pain and normal electrocardiograms and troponin values compared to standard care with a functional test. (Cardiac-CT in the Treatment of Acute Chest Pain [CATCH]; NCT01534000).
Authors: Adriane E Napp; Robert Haase; Michael Laule; Georg M Schuetz; Matthias Rief; Henryk Dreger; Gudrun Feuchtner; Guy Friedrich; Miloslav Špaček; Vojtěch Suchánek; Klaus Fuglsang Kofoed; Thomas Engstroem; Stephen Schroeder; Tanja Drosch; Matthias Gutberlet; Michael Woinke; Pál Maurovich-Horvat; Béla Merkely; Patrick Donnelly; Peter Ball; Jonathan D Dodd; Martin Quinn; Luca Saba; Maurizio Porcu; Marco Francone; Massimo Mancone; Andrejs Erglis; Ligita Zvaigzne; Antanas Jankauskas; Gintare Sakalyte; Tomasz Harań; Malgorzata Ilnicka-Suckiel; Nuno Bettencourt; Vasco Gama-Ribeiro; Sebastian Condrea; Imre Benedek; Nada Čemerlić Adjić; Oto Adjić; José Rodriguez-Palomares; Bruno Garcia Del Blanco; Giles Roditi; Colin Berry; Gershan Davis; Erica Thwaite; Juhani Knuuti; Mikko Pietilä; Cezary Kępka; Mariusz Kruk; Radosav Vidakovic; Aleksandar N Neskovic; Ignacio Díez; Iñigo Lecumberri; Jacob Geleijns; Christine Kubiak; Anke Strenge-Hesse; The-Hoang Do; Felix Frömel; Iñaki Gutiérrez-Ibarluzea; Gaizka Benguria-Arrate; Hans Keiding; Christoph Katzer; Jacqueline Müller-Nordhorn; Nina Rieckmann; Mario Walther; Peter Schlattmann; Marc Dewey Journal: Eur Radiol Date: 2016-11-18 Impact factor: 5.315
Authors: Jesper J Linde; Mathias Sørgaard; Jørgen T Kühl; Jens D Hove; Henning Kelbæk; Walter B Nielsen; Klaus F Kofoed Journal: Int J Cardiovasc Imaging Date: 2016-10-07 Impact factor: 2.357
Authors: Anke Busse; Daniel Cantré; Ebba Beller; Felix Streckenbach; Alper Öner; Hüseyin Ince; Marc-André Weber; Felix G Meinel Journal: Radiologe Date: 2019-12 Impact factor: 0.635
Authors: Alasdair J Gray; Carl Roobottom; Jason E Smith; Steve Goodacre; Katherine Oatey; Rachel O'Brien; Robert F Storey; Lumine Na; Steff C Lewis; Praveen Thokala; David E Newby Journal: Trials Date: 2016-12-07 Impact factor: 2.279
Authors: George Cm Siontis; Dimitris Mavridis; John P Greenwood; Bernadette Coles; Adriani Nikolakopoulou; Peter Jüni; Georgia Salanti; Stephan Windecker Journal: BMJ Date: 2018-02-21
Authors: Khaled M Abdelrahman; Marcus Y Chen; Amit K Dey; Renu Virmani; Aloke V Finn; Ramzi Y Khamis; Andrew D Choi; James K Min; Michelle C Williams; Andrew J Buckler; Charles A Taylor; Campbell Rogers; Habib Samady; Charalambos Antoniades; Leslee J Shaw; Matthew J Budoff; Udo Hoffmann; Ron Blankstein; Jagat Narula; Nehal N Mehta Journal: J Am Coll Cardiol Date: 2020-09-08 Impact factor: 24.094
Authors: Alasdair J Gray; Carl Roobottom; Jason E Smith; Steve Goodacre; Katherine Oatey; Rachel O'Brien; Robert F Storey; Nick Curzen; Liza Keating; Attila Kardos; Dirk Felmeden; Robert J Lee; Praveen Thokala; Steff C Lewis; David E Newby Journal: BMJ Date: 2021-09-29