Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT).

Autor:	Aziz W; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK., Morgan H; British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK., Demir OM; British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK., Sinha A; British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK., Rua T; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK., Rajani R; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK., Chang AL; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Woo E; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Mak SM; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Benedetti G; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Villa A; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Preston R; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Navin R; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., O'Kane K; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Hunter L; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Ismail T; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK., Carr-White G; Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK., Beckley-Hoelscher N; Division of Health and Social Care Research, King's College London, London, UK., Peacock J; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA., Marber M; British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK., Razavi R; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK., Perera D; British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK divaka.perera@kcl.ac.uk.
Jazyk:	angličtina
Zdroj:	Heart (British Cardiac Society) [Heart] 2022 Nov 24; Vol. 108 (24), pp. 1972-1978. Date of Electronic Publication: 2022 Nov 24.
DOI:	10.1136/heartjnl-2022-320990
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© 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.)
Databáze:	MEDLINE
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