Myocardial perfusion 320-row multidetector computed tomography-guided treatment strategy for the clinical management of patients with recent acute-onset chest pain: Design of the CArdiac cT in the treatment of acute CHest pain (CATCH)-2 randomized controlled trial.
OBJECTIVE
Patients admitted with chest pain are a diagnostic challenge because the majority does not have coronary artery disease (CAD). Assessment of CAD with coronary computed tomography angiography (CCTA) is safe, cost-effective, and accurate, albeit with a modest specificity. Stress myocardial computed tomography perfusion (CTP) has been shown to increase the specificity when added to CCTA, without lowering the sensitivity. This article describes the design of a randomized controlled trial, CATCH-2, comparing a clinical diagnostic management strategy of CCTA alone against CCTA in combination with CTP.


METHODS
Patients with acute-onset chest pain older than 50 years and with at least one cardiovascular risk factor for CAD are being prospectively enrolled to this study from 6 different clinical sites since October 2013. A total of 600 patients will be included. Patients are randomized 1:1 to clinical management based on CCTA or on CCTA in combination with CTP, determining the need for further testing with invasive coronary angiography including measurement of the fractional flow reserve in vessels with coronary artery lesions. Patients are scanned with a 320-row multidetector computed tomography scanner. Decisions to revascularize the patients are taken by the invasive cardiologist independently of the study allocation. The primary end point is the frequency of revascularization. Secondary end points of clinical outcome are also recorded.


CONCLUSIONS
The CATCH-2 will determine whether CCTA in combination with CTP is diagnostically superior to CCTA alone in the management of patients with acute-onset chest pain.
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: mathiassoergaard@hotmail.com.
Mathias
M
Sørgaard
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Jesper J
JJ
Linde
Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
Jens D
JD
Hove
Department of Cardiology, Amager Hospital, Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Jan R
JR
Petersen
Department of Cardiology, Amager Hospital, Copenhagen, University of Copenhagen, Copenhagen, Denmark.
Tem B S
TB
Jørgensen
Department of Medicine, Division of Cardiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
Jawdat
J
Abdulla
Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Merete
M
Heitmann
Department of Cardiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
Charlotte
C
Kragelund
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Thomas Fritz
TF
Hansen
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Patricia M
PM
Udholm
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Christian
C
Pihl
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
J Tobias
JT
Kühl
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Thomas
T
Engstrøm
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Jan Skov
JS
Jensen
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Dan E
DE
Høfsten
Department of Cardiology, Roskilde Sygehus, University of Copenhagen, Copenhagen, Denmark.
Henning
H
Kelbæk
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Klaus F
KF
Kofoed
D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D019468:Disease Management; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D061330:Multidetector Computed Tomography; D055414:Myocardial Perfusion Imaging; D012680:Sensitivity and Specificity; D061205:Vascular Calcification / Q000000981:diagnostic imaging