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)

ObjectivesIn 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.Methods and resultsWe 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).ConclusionIn 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.