title: The role of cardiovascular magnetic resonance imaging and computed tomography angiography in suspected non-ST-elevation myocardial infarction patients: design and rationale of the CARdiovascular Magnetic rEsoNance imaging and computed Tomography Angiography (CARMENTA) trial.
abstract: BACKGROUND
  Although high-sensitivity cardiac troponin (hs-cTn) substantially improves the early detection of myocardial injury, it lacks specificity for acute myocardial infarction (MI). In suspected non-ST-elevation MI, invasive coronary angiography (ICA) remains necessary to distinguish between acute MI and noncoronary myocardial disease (eg, myocarditis), unnecessarily subjecting the latter to ICA and associated complications. This trial investigates whether implementing cardiovascular magnetic resonance (CMR) or computed tomography angiography (CTA) early in the diagnostic process may help to differentiate between coronary and noncoronary myocardial disease, thereby preventing unnecessary ICA.
  
  
  METHODS
  In this prospective, single-center, randomized controlled clinical trial, 321 consecutive patients with acute chest pain, elevated hs-cTnT, and nondiagnostic electrocardiogram are randomized to 1 of 3 strategies: (1) CMR, or (2) CTA early in the diagnostic process, or (3) routine clinical management. In the 2 investigational arms of the study, results of CMR or CTA will guide further clinical management. It is expected that noncoronary myocardial disease is detected more frequently after early noninvasive imaging as compared with routine clinical management, and unnecessary ICA will be prevented. The primary end point is the total number of patients undergoing ICA during initial admission. Secondary end points are 30-day and 1-year clinical outcome (major adverse cardiac events and major procedure-related complications), time to final diagnosis, quality of life, and cost-effectiveness.
  
  
  CONCLUSIONS
  The CARMENTA trial investigates whether implementing CTA or CMR early in the diagnostic process in suspected non-ST-elevation MI based on elevated hs-cTnT can prevent unnecessary ICA as compared with routine clinical management, with no detrimental effect on clinical outcome.
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Smulders
authors.forename: Bastiaan L J H
authors.initials: BL
authors.lastname: Kietselaer
authors.forename: Marco
authors.initials: M
authors.lastname: Das
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.forename: Leo F
authors.initials: LF
authors.lastname: Veenstra
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
authors.forename: Marja P
authors.initials: MP
authors.lastname: van Dieijen-Visser
authors.forename: Alma M A
authors.initials: AM
authors.lastname: Mingels
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Dagnelie
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Post
authors.forename: Anton P M
authors.initials: AP
authors.lastname: Gorgels
authors.forename: Antoinette D I
authors.initials: AD
authors.lastname: van Asselt
authors.forename: Gaston
authors.initials: G
authors.lastname: Vogel
authors.forename: Simon
authors.initials: S
authors.lastname: Schalla
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Kim
authors.forename: Sebastiaan C A M
authors.initials: SC
authors.lastname: Bekkers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D019468:Disease Management; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult