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: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark. Electronic address: jesper_linde@hotmail.com.
authors.forename: Jesper James
authors.initials: JJ
authors.lastname: Linde
authors.forename: Klaus Fuglsang
authors.initials: KF
authors.lastname: Kofoed
authors.forename: Mathias
authors.initials: M
authors.lastname: Sørgaard
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Gorm Boje
authors.initials: GB
authors.lastname: Jensen
authors.forename: Walter Bjørn
authors.initials: WB
authors.lastname: Nielsen
authors.forename: Jens Dahlgaard
authors.initials: JD
authors.lastname: Hove
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000401:mortality; D057791:Cardiac Imaging Techniques / Q000379:methods*; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000401:mortality; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000401:mortality; D011237:Predictive Value of Tests; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019209:Troponin C / Q000097:blood*
chemical_list: D019209:Troponin C
keywords: Acute coronary syndrome; Angina pectoris; Cardiac computed tomographic angiography; Ischaemic heart disease