Coronary CT Angiography as the Primary Initial Method of Evaluating Patients With Subacute Chest Pain (CT PRIME) (CTPRIME)
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Purpose
This study is designed to evaluate a new approach to the diagnosis of chronic or sub-acute chest pain patients in the out-patient setting. Patients in this study are selected to be "low-risk", meaning they are not having an acute or recent heart attack (AMI), based on screening blood tests and electrocardiograms (EKGs). In addition, these patients have a low or intermediate pre-test likelihood of the coronary artery disease (CAD), which means that probability of the CAD based on the available clinical and historical information, does not make a diagnosis of the CAD a certain clinical diagnosis in the particular patient and this, in turn, requires an additional diagnostic work up.
| Condition |
|---|
|
Coronary Artery Disease |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | Coronary CT Angiography as the Primary Initial Method of Evaluating Patients With Subacute Chest Pain (CT PRIME) |
- Primary outcome variable: diagnostic efficiency. [ Time Frame: 6 months, 1 year ] [ Designated as safety issue: Yes ]
- Secondary outcome variables: diagnostic accuracy, prognostic accuracy. [ Time Frame: 6 months, 1 year ] [ Designated as safety issue: Yes ]
| Estimated Enrollment: | 300 |
| Study Start Date: | January 2008 |
| Estimated Study Completion Date: | June 2010 |
| Estimated Primary Completion Date: | June 2009 (Final data collection date for primary outcome measure) |
| Groups/Cohorts |
|---|
| 1 |
| 2 |
Detailed Description:
To compare and contrast the diagnostic efficacy of coronary CT angiography (CCTA) to standard of care-myocardial perfusion imaging (MPI) as an initial diagnostic test for evaluation of patients with suspected angina pectoris and no known CAD.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Probability Sample |
Volunteers over 18 years of age; both genders; referred from participating cardiologist's offices
Inclusion Criteria:
- Non-acute (onset≥72 hours) chest pain suggestive of possible underlying CAD in out-patient.
- Low or low-to-intermediate clinical likelihood of the CAD.
- Very low or low risk Goldman-Reilly risk group.
- Ability to provide informed consent.
- Age equal to or greater than 18 years.
Exclusion Criteria:
Intermediate or higher risk of ACS by Goldman-Reilly criteria:
- Electrographic evidence of acute ST elevation myocardial infarction (STEMI) with ST segment elevation equal to or greater than 1mm in two or more contiguous leads).
- Electrocardiographic evidence of acute non-ST infarction (NSTEMI) or acute myocardial ischemia, including flat to down sloping ST segment depression equal to or greater than 1mm and/or T wave inversion equal to or greater than 2mm in 2 or more leads.
- Positive cardiac biomarkers (troponin and/or creatinine phosphokinase MB fraction) compatible with acute myocardial infarction on initial laboratory testing, based on the local laboratory upper range of normal.
- Clinical instability including cardiogenic shock, hypotension (systolic blood pressure < 90 mmHg), refractory hypertension (systolic blood pressure > 180 mmHg on therapy), sustained ventricular or atrial arrhythmia requiring intravenous medications.
- Presence of known pre-existing coronary artery disease (known prior myocardial infarction, EKG evidence compatible with prior infarction, prior angiographic evidence of significant coronary artery disease, history of prior coronary revascularization).
- Presence of signs or symptoms compatible with obvious non-cardiac chest pain, including musculoskeletal, gastrointestinal or neuropathic causes.
- Renal insufficiency (creatinine >1.5) or history of chronic or transient renal failure.
- Atrial fibrillation or other markedly irregular rhythm.
- Pregnancy or unknown pregnancy status.
- Known allergy to iodinated contrast.
- Inability to tolerate beta-blocking drugs, including patients with reactive airways disease requiring maintenance inhaled bronchodilators or steroids, complete heart block or second-degree atrioventricular block.
- Iodinated contrast administration within the past 48 hours.
Contacts and Locations| United States, Michigan | |
| William Beaumont Hospital | |
| Royal Oak, Michigan, United States, 48073 | |
| Principal Investigator: | Aiden Abidov, MD, PhD | William Beaumont Hospitals |
More Information
No publications provided
| Responsible Party: | Aiden Abidov MD, PhD, Division of Cardiology, William Beaumont Hospital |
| ClinicalTrials.gov Identifier: | NCT00584337 History of Changes |
| Other Study ID Numbers: | 2007-091 |
| Study First Received: | December 20, 2007 |
| Last Updated: | April 21, 2009 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by William Beaumont Hospitals:
|
tomography coronary artery disease Stress Test |
Coronary CT Angiography Diagnostic Accuracy Non invasive testing |
Additional relevant MeSH terms:
|
Chest Pain Coronary Artery Disease Myocardial Ischemia Coronary Disease Pain Signs and Symptoms |
Heart Diseases Cardiovascular Diseases Arteriosclerosis Arterial Occlusive Diseases Vascular Diseases |
ClinicalTrials.gov processed this record on May 19, 2013