Rationale and design of a randomized controlled trial comparing stress myocardial perfusion imaging with coronary CT angiography as the initial imaging study for intermediate-risk patients admitted with chest pain

Rationale and Design of a Randomized Trial Comparing Initial Stress Echocardiography versus Coronary CT Angiography in Low‐to‐Intermediate Risk Emergency Department Patients with Chest Pain

“…The two RCTs assessing early CTA in ED chest pain patients published at the time this study was planned demonstrate that 69–75% of low‐to‐intermediate risk patients can be discharged on the basis of CTA results. We expect a similar discharge rate in our population, given the rate of abnormalities found on CTA in our patient population . This yields a hypothetical admission rate of ~28%, which is similar to that reported in a subsequent multicenter RCT .…”

“…We expect a similar discharge rate in our population, given the rate of abnormalities found on CTA in our patient population. 34 This yields a hypothetical admission rate of~28%, which is similar to that reported in a subsequent multicenter RCT. 6 Based on an institution database of >7000 SE studies, the exam is inconclusive in~10% of All five criteria must be present for eligibility.…”

Coronary Computed Tomography Angiography Versus Radionuclide Myocardial Perfusion Imaging in Patients With Chest Pain Admitted to Telemetry

“…Assessors of the primary outcome were blinded to trial arm; patients, imagers, coronary angiographers and managing clinicians were not blinded. The complete trial design and rationale has been previously described (25). The study was approved by our institutional review board, HIPAA compliant, overseen by an independent Data and Safety Monitoring Board and registered at ClinicalTrials.gov (NCT00705458).…”

“…The study had 84% power to detect a reduction of catheterization not leading to revascularization from 11% to 3% with a sample size of 200 per arm at α=0.05 (25). All randomized patients were included in the analysis in the trial arm to which they randomized.…”

Cardiac CT: Practical approach to integrate appropriate indications in daily practice

“…Several reports have recently outlined the feasibility and the potential of perfusion CCT (rest CCT and pharmacologic stress CCT) in the detection of ischemic myocardium [42][43][44][45] with accuracy. Even if theoretical incremental value of ischemia detection in the same examination than coronary assessment is of interest, the place of such procedure requires further evaluations.…”