title: Long-Term Clinical Impact of Coronary CT Angiography in Patients With Recent Acute-Onset Chest Pain: The Randomized Controlled CATCH Trial.
abstract: OBJECTIVE
  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.affiliation: 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.
authors.forename: Jesper J
authors.initials: JJ
authors.lastname: Linde
authors.affiliation: 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.
authors.forename: Jens D
authors.initials: JD
authors.lastname: Hove
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mathias
authors.initials: M
authors.lastname: Sørgaard
authors.affiliation: Department of Cardiology, Roskilde Sygehus, Roskilde, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.affiliation: Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors.forename: Gorm B
authors.initials: GB
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jørgen T
authors.initials: JT
authors.lastname: Kühl
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Hindsø
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors.forename: Walter B
authors.initials: WB
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Kofoed
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality; D004311:Double-Blind Method; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: acute chest pain; clinical outcome; coronary artery disease; coronary computed tomographic angiography; exercise electrocardiogram