Evaluating ECG-less Coronary CT Angiography for Diagnosing Coronary Artery Disease in Patients With High Troponin Chest Pain at the Emergency Room

What this Trial Is About

Chest pain is a common reason for emergency room visits and can result from a range of conditions, from mild musculoskeletal issues to serious diseases like aortic dissection, pulmonary embolism, and myocardial infarction. This trial evaluates a new ECG-less computed tomography angiography CCTA system called the Revolution Apex Elite to diagnose coronary artery disease CAD in patients with high troponin chest pain, comparing it to the current gold standard invasive coronary angiography ICA. The study also looks at the ability of this new CT system to identify alternative diagnoses and predict outcomes like myocardial infarction, coronary revascularization, and cardiac death over 18 months. Participants undergo a non-ECG-gated CT scan using the Revolution Apex Elite system, which captures images of the pulmonary, aortic, and coronary arteries with a single contrast injection and without the need for ECG leads. This scan is fast, taking about 12 minutes, and uses advanced software to enhance image quality. After the CT scan, patients will have an invasive coronary angiography within 24 hours. Both patients and cardiologists are blinded to the CT results except when an alternative diagnosis is found. Treatment decisions follow current guidelines, including possible revascularization based on ICA findings. Throughout the study, patients will be assessed for CAD using both CT and ICA images, with image analysis done by blinded radiologists. Researchers will measure the accuracy of the new CT method in detecting obstructive and high-risk coronary disease and evaluate its predictive value for cardiac events over time. The study duration includes follow-up for up to 18 months to monitor outcomes like myocardial infarction and cardiac death. Safety and diagnostic results will guide future use of this non-invasive imaging technique in chest pain management.

ECG-less Coronary Computed Tomography Angiography in the Management of Patients Presenting With High-troponin Chest Pain