Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT)

TY - JOUR

T1 - Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT)

AU - Aziz, Waqar

AU - Morgan, Holly

AU - Demir, Ozan M.

AU - Sinha, Aish

AU - Rua, Tiago

AU - Rajani, Ronak

AU - Chang, Ai Lee

AU - Woo, Eric

AU - Mak, Sze Mun

AU - Benedetti, Giulia

AU - Villa, Adriana

AU - Preston, Rebecca

AU - Navin, Roshan

AU - O'Kane, Kevin

AU - Hunter, Laura

AU - Ismail, Tevfik

AU - Carr-White, Gerry

AU - Beckley-Hoelscher, Nick

AU - Peacock, Janet

AU - Marber, Michael

AU - Razavi, Reza

AU - Perera, Divaka

N1 - Funding Information: The study was completed under our institutional initiative named Transforming Outcomes and Health Economics Through Imaging (TOHETI) and funded by Guy’s and St Thomas’ Charity. Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2022/10/26

Y1 - 2022/10/26

N2 - Objective Many patients presenting with suspected acute coronary syndrome (ACS) have high-sensitivity cardiac troponin (hs-cTn) concentrations between rule-in and rule-out thresholds and hence need serial testing, which is time consuming. The Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT) assessed the utility of coronary CT angiography (CCTA) in patients with suspected ACS, non-ischaemic ECG and intermediate initial hs-cTn concentration. Methods Patients were randomised to CCTA-guided management versus standard of care (SOC). The primary outcome was hospital length of stay (LOS). Secondary outcomes included cost of in-hospital stay and major adverse cardiac events (MACE) at 12 months of follow-up. Data are mean (SD); for LOS harmonic means, IQRs are shown. Results 250 (aged 55 (14) years, 25% women) patients were randomised. Harmonic mean (IQR) LOS was 7.53 (6.0-9.6) hours in the CCTA arm and 8.14 (6.3-9.8) hours in the SOC arm (p=0.13). Inpatient cost was £1285 (£2216) and £1108 (£3573), respectively, p=0.68. LOS was shorter in the CCTA group in patients with <25% stenosis, compared with SOC; 6.6 (5.6-7.8) hours vs 7.5 (6.1-9.4) hours, respectively; p=0.021. More referrals for cardiology outpatient clinic review and cardiac CT-related outpatient referrals occurred in the SOC arm (p=0.01). 12-month MACE rates were similar between the two arms (7 (5.6%) in the CCTA arm and 8 (6.5%) in the SOC arm - log-rank p=0.78). Conclusions CCTA did not lead to reduced hospital LOS or cost, largely because these outcomes were influenced by the detection of ≥25% grade stenosis in a proportion of patients. Trial registration number NCT03583320.

AB - Objective Many patients presenting with suspected acute coronary syndrome (ACS) have high-sensitivity cardiac troponin (hs-cTn) concentrations between rule-in and rule-out thresholds and hence need serial testing, which is time consuming. The Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT) assessed the utility of coronary CT angiography (CCTA) in patients with suspected ACS, non-ischaemic ECG and intermediate initial hs-cTn concentration. Methods Patients were randomised to CCTA-guided management versus standard of care (SOC). The primary outcome was hospital length of stay (LOS). Secondary outcomes included cost of in-hospital stay and major adverse cardiac events (MACE) at 12 months of follow-up. Data are mean (SD); for LOS harmonic means, IQRs are shown. Results 250 (aged 55 (14) years, 25% women) patients were randomised. Harmonic mean (IQR) LOS was 7.53 (6.0-9.6) hours in the CCTA arm and 8.14 (6.3-9.8) hours in the SOC arm (p=0.13). Inpatient cost was £1285 (£2216) and £1108 (£3573), respectively, p=0.68. LOS was shorter in the CCTA group in patients with <25% stenosis, compared with SOC; 6.6 (5.6-7.8) hours vs 7.5 (6.1-9.4) hours, respectively; p=0.021. More referrals for cardiology outpatient clinic review and cardiac CT-related outpatient referrals occurred in the SOC arm (p=0.01). 12-month MACE rates were similar between the two arms (7 (5.6%) in the CCTA arm and 8 (6.5%) in the SOC arm - log-rank p=0.78). Conclusions CCTA did not lead to reduced hospital LOS or cost, largely because these outcomes were influenced by the detection of ≥25% grade stenosis in a proportion of patients. Trial registration number NCT03583320.

KW - acute coronary syndrome

KW - chest pain

KW - computed tomography angiography

KW - coronary artery disease

UR - https://www.scopus.com/pages/publications/85141559046

U2 - 10.1136/heartjnl-2022-320990

DO - 10.1136/heartjnl-2022-320990

M3 - Article

C2 - 36288924

AN - SCOPUS:85141559046

SN - 1355-6037

VL - 108

SP - 1972

EP - 1978

JO - Heart

JF - Heart

IS - 24

ER -