Coronary CT Angiography in Non ST-elevation Myocardial Infarction

  • STATUS
    Recruiting
  • End date
    Oct 26, 2023
  • participants needed
    300
  • sponsor
    St. Olavs Hospital
Updated on 26 January 2021

Summary

Non ST-elevation myocardial infarction (NSTEMI) represents 70-75% of all myocardial infarctions. Current guidelines recommend invasive angiography and this patient group represents a major burden on the invasive catheterization laboratories and the health care system.

The coronary pathology found in NSTEMI-patients varies substantially, ranging from structurally normal vessels, non-obstructive atherosclerosis to severe multivessel disease. 30-40 % of patients with NSTEMI undergoing invasive coronary angiography do not undergo revascularization. If these patients could be identified by a non-invasive method like coronary CT angiography (CCTA), an invasive procedure with the potential risk for complications could be avoided. Furthermore, less patients would need transfer to an invasive center. Both for patients and for health care costs this would be of major benefit.

The quality of CCTA images has improved during the years, and radiation dose has decreased. Due to technological development it is now possible to perform high quality coronary CCTA with a very low radiation dose (1-1.5 mSv) compared to a radiation dose of 3-4 mSv for invasive coronary angiography.

The overall aim of the project is to define a subpopulation of NSTEMI patients that preferably should undergo CCTA as the first step in imaging of the coronary arteries and thus potentially be saved from an unnecessary invasive investigation. This would result in less patient discomfort, less patient risk and reduced health care costs. Patients with a clinical indication for invasive angiography according to current guidelines will undergo CCTA prior to the invasive investigation. The ability of CCTA to identify those with no need for revascularization will be assessed using invasive angiography as the gold standard.

Details
Condition Non-ST-elevation Myocardial Infarction
Treatment Invasive coronary angiography, Coronary CT Angiography
Clinical Study IdentifierNCT04537741
SponsorSt. Olavs Hospital
Last Modified on26 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

admitted to a local hospital with NSTEMI type 1 or type 2 based on clinical criteria
indication for invasive coronary angiography according to current guidelines

Exclusion Criteria

indication for immediate (< 2 hours) invasive strategy according to guidelines
GRACE score > 140
not willing to provide written informed consent
previous coronary revascularization
estimated glomerular filtration rate < 30 mL/min/1,73m2
allergic reactions to contrast agents impeding for safe examinations
> 2 hypokinetic segments on echocardiography
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