Author + information
- Received August 21, 2017
- Revision received September 23, 2017
- Accepted September 27, 2017
- Published online November 5, 2018.
- Mathias H. Sørgaard, MDa,
- Jesper J. Linde, MDa,
- J. Tobias Kühl, MDb,
- Henning Kelbæk, MDc,
- Jens D. Hove, MDd,
- Gitte G. Fornitz, MDe,
- Tem B.S. Jørgensen, MDe,
- Merete Heitmann, MDb,
- Charlotte Kragelund, MDf,
- Thomas F. Hansen, MDg,
- Jawdat Abdulla, MDh,
- Thomas Engstrøm, MDa,
- Jan S. Jensen, MDg,
- Yaffah T. Wiegandt, BSa,
- Dan E. Høfsten, MDa,
- Lars V. Køber, MDa and
- Klaus F. Kofoed, MDa,i,∗ ()
- aDepartment of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- bDepartment of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- cDepartment of Cardiology, Zealand University Hospital, Roskilde, Denmark
- dDepartment of Cardiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- eDepartment of Cardiology, Amager Hospital, Copenhagen, University of Copenhagen, Copenhagen, Denmark
- fDepartment of Cardiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
- gDepartment of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- hDepartment of Medicine, Division of Cardiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
- iDepartment of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- ↵∗Address for correspondence:
Dr. Klaus F. Kofoed, Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100-CPH, Denmark.
Objectives The authors sought to perform a randomized controlled trial to evaluate the clinical efficacy of combined examination with coronary computed tomography angiography (CTA) and computed tomography perfusion imaging (CTP) compared to coronary CTA alone.
Background Stress myocardial CTP may increase diagnostic specificity when added to coronary CTA in patients suspected of having ischemic heart disease.
Methods Patients recently hospitalized for acute-onset chest pain, who had acute coronary syndrome had been ruled out by normal electrocardiograms, normal troponin levels, and relief of symptoms, and who had a clinical indication for outpatient noninvasive testing, were screened for inclusion in the CATCH-2 (CArdiac cT in the treatment of acute CHest pain 2) trial (NCT02014311). Patients were randomized 1:1 to examination with coronary CTA or coronary CTA+CTP. The primary endpoint was the frequency of coronary revascularization among patients referred for invasive coronary angiography (ICA) based on index computed tomography evaluation. Secondary endpoints were invasive procedural complications at index-related ICA, post-index cardiac death, hospital admittance because of recurrence of chest pain, unstable angina pectoris, or acute myocardial infarction, ICA, and revascularization.
Results Among 300 patients allocated to the coronary CTA+CTP group, 41 (14%) were referred for ICA compared with 89 (30%) allocated to coronary CTA (p < 0.0001). The primary endpoint occurred in 50% of coronary CTA+CTP patients versus 48% of invasively examined patients (p = 0.85). The total number of revascularizations was significantly lower in the coronary CTA+CTP group compared to the coronary CTA group (n = 20 [7%] vs. n = 42 [14%]; p = 0.0045). At median follow-up of 1.5 years, the occurrence of secondary endpoints was similar in the 2 groups.
Conclusions A post-discharge diagnostic strategy of coronary CTA+CTP safely reduces the need for invasive examination and treatment in patients suspected of having ischemic heart disease. (CArdiac cT in the treatment of acute CHest pain 2–Myocardial CT Perfusion [CATCH2]; NCT02014311)
This study was supported by AP Møller og hustru Chastine McKinney Møllers Fond, Copenhagen; The Danish Agency for Science Technology and Innovation, Copenhagen; The Danish Council for Strategic Research, Copenhagen; The Research Council of Rigshopitalet, Copenhagen; Toshiba Medical Systems Corporation, Otawara, Japan; and The University of Copenhagen, Copenhagen. The funding sources did not have any role in the study design; conduct of the study; data analysis; data interpretation; or writing of this report. Dr. Sørgaard has received research grants from The Research Council of Rigshospitalet; and lecturing fees from Toshiba Medical Systems Corporation. Dr. Kofoed has received an unrestricted grant from Toshiba Medical Systems Corporation. Dr. Engstrøm has received Speakers Bureau fees and Advisory Board fees from Boston Scientific, St. Jude Medical, AstraZeneca, and Bayer AS. Dr. Fornitz has received advisory board fees from Bayer, Bristol-Myers Squibb, and Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 21, 2017.
- Revision received September 23, 2017.
- Accepted September 27, 2017.
- 2018 American College of Cardiology Foundation