The goal of this research is to determine noninvasively whether detection of coronary stenosis and plaque by multidetector computed tomography (MDCT) in patients with acute chest pain suspected of acute coronary syndrome (ACS) enhances triage, reduces cost and is cost effective. Among the 5.6 million patients with ACP presenting annually in emergency departments (ED) in the United States, a subgroup of two million patients is hospitalized despite normal initial cardiac biomarker tests and electrocardiogram (ECG). This subgroup is at low (20%) risk for ACS during the index hospitalization. Most (80-94%) patients with a diagnosis of ACS have a significant epicardial coronary artery stenosis ( >50% luminal narrowing). However, in -10% of patients non-stenotic coronary plaque triggers events, i.e. vasospasms, leading to myocardial ischemia. Since the absence of plaque excludes a coronary cause of chest pain, these patients could in theory be discharged earlier reducing unnecessary hospital admissions. Recent publications demonstrate high sensitivity and specificity of MDCT for the detection of significant coronary stenosis compared with coronary angiography and the detection of coronary plaque as validated with intravascular ultrasound. Using 64- slice MDCT we propose to study 400 patients with ACP, negative initial cardiac biomarkers and non-diagnostic ECG. We will analyze MDCT images for the presence of significant coronary artery stenosis and plaque and correlate the data with the clinical diagnosis of ACS (AHA guidelines) during the index hospitalization to determine the sensitivity and specificity. MDCT data, risk factors, and the results of standard diagnostic tests available at the time of MDCT will be used to generate a multivariate prediction function and derive a clinical decision rule. Based on this decision rule we will compare the diagnostic accuracies and cost effectiveness of competing strategies. We hypothesize that an MDCT- based diagnostic strategy will reduce the time to diagnosis of ACS, number of hospitalizations, and absolute cost of management of patients with acute chest pain compared to standard clinical care and is cost effective.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL080053-03
Application #
7339029
Study Section
Special Emphasis Panel (ZRG1-CICS (01))
Program Officer
Desvigne-Nickens, Patrice
Project Start
2006-02-15
Project End
2009-12-31
Budget Start
2008-01-01
Budget End
2009-12-31
Support Year
3
Fiscal Year
2008
Total Cost
$522,822
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
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Pursnani, Amit; Schlett, Christopher L; Mayrhofer, Thomas et al. (2015) Potential for coronary CT angiography to tailor medical therapy beyond preventive guideline-based recommendations: insights from the ROMICAT I trial. J Cardiovasc Comput Tomogr 9:193-201
Maurovich-Horvat, Pál; Kallianos, Kimberly; Engel, Leif-Christopher et al. (2015) Relationship of thoracic fat depots with coronary atherosclerosis and circulating inflammatory biomarkers. Obesity (Silver Spring) 23:1178-84
Ferencik, Maros; Liu, Ting; Mayrhofer, Thomas et al. (2015) hs-Troponin I Followed by CT Angiography Improves Acute Coronary Syndrome Risk Stratification Accuracy and Work-Up in Acute Chest Pain Patients: Results From ROMICAT II Trial. JACC Cardiovasc Imaging 8:1272-1281
Pursnani, Amit; Lee, Ashley M; Mayrhofer, Thomas et al. (2015) Early resting myocardial computed tomography perfusion for the detection of acute coronary syndrome in patients with coronary artery disease. Circ Cardiovasc Imaging 8:e002404
Pursnani, Amit; Mayrhofer, Thomas; Ferencik, Maros et al. (2014) The 2013 ACC/AHA cardiovascular prevention guidelines improve alignment of statin therapy with coronary atherosclerosis as detected by coronary computed tomography angiography. Atherosclerosis 237:314-8
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Siegel, Emily; Thai, Wai-Ee; Techasith, Tust et al. (2013) Aortic distensibility and its relationship to coronary and thoracic atherosclerosis plaque and morphology by MDCT: insights from the ROMICAT Trial. Int J Cardiol 167:1616-21
Schlett, Christopher L; Truong, Quynh A; Ahmed, Waleed et al. (2013) High-sensitivity troponin T and C-reactive protein to identify patients without cardiac structural and functional abnormalities as assessed by cardiac CT and SPECT imaging: can biomarkers predict cardiac health? Int J Cardiovasc Imaging 29:865-73
Blankstein, Ron; Ahmed, Waleed; Bamberg, Fabian et al. (2012) Comparison of exercise treadmill testing with cardiac computed tomography angiography among patients presenting to the emergency room with chest pain: the Rule Out Myocardial Infarction Using Computer-Assisted Tomography (ROMICAT) study. Circ Cardiovasc Imaging 5:233-42

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