Coronary Computed Tomography Angiography For Optimized Invasive Coronary examInation (CT-FOCI)

  • STATUS
    Recruiting
  • End date
    Jul 1, 2023
  • participants needed
    120
  • sponsor
    Aarhus University Hospital Skejby
Updated on 28 May 2022
luminal
angiography
computed tomography angiography
stenosis
angina pectoris
stable angina
dapt

Summary

Coronary computed tomography angiography (CCTA) is a non-invasive method for visualization of the coronary arteries. The anatomical information obtained by CCTA, however, is rarely integrated into a subsequent coronary intervention. The CT-FOCI trial aims to evaluate, in a randomized setting, the benefit of implementing the information obtained by CCTA as part of the invasive examination using a CT-guided algorithm (CTGA). Patients (n=120) with symptoms of stable angina pectoris will be randomized 1:1 after CCTA has determined at least 1 stenosis with luminal diameter reduction of minimum 50% in a vessel segment > 2 mm in diameter. Subsequent, invasive examination and intervention will utilize the information available according to randomization. Primary efficacy endpoints are a reduction in patient radiation exposure, procedure time, procedural utensils, and contrast use.

Secondary endpoints is significant stenosis in the non-target vessel, only available in the conventional group.

Description

The study is a randomized, single center trial. Patients (n=120) referred for CCTA due to symptoms suggesting obstructive coronary disease (shortness of breath on exertion or angina in relation to activity), are randomized 1:1 if CCTA finds coronary lesions suggestive of obstructive coronary artery disease in at lest one vessel and thus indication for further investigation by invasive examination.

The patients are randomized to a standard treatment (ST) and a protocol with a CT-guided algorithm (CTGA) for optimal interventional work-flow. ST includes the use of two diagnostic cathers and examination of both coronary arteries by at least 6 different standard projections best optimizing the view of the coronary lesions. Additional projections may be included if deemed necessary for optimal angiographic evaluation. Procedural time consumption (timepoint 1) is measured at the completion of the angiogram as specified (7.4.2). If there is a switch to a guiding catheter and subsequent coronary physiology test (fractional flow reserve [FFR]) this is marked at timepoint 2 at the conclusion of the FFR.

In the CTGA group only the artery suspected of having obstructive coronary disease is examined. Anatomy of the vessel, optimal viewing projections and choice of catheter is determined. A guiding catheter is used as first choice based on the artery involved and the aortic anatomy. Time is recorded according to the ST group, with timepoint 1 after conclusion of the angiogram, timepoint 2 after FFR.

On the day of invasive examination, the total amount of contrast, radiation dose, procedural time consumption and cost of utensils are registered as primary endpoints. In the conventional group, any significant stenosis in the non-target vessel

Details
Condition Ischemic Heart Disease, Coronary Artery Disease
Treatment CCTA guided focused coronary angiography examination.
Clinical Study IdentifierNCT05218694
SponsorAarhus University Hospital Skejby
Last Modified on28 May 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Age > 18 and < 81 years
Stable angina
at least 1 vessel disease in either the left coronary artery or right coronary artery
Stenosis grater than 50% and no stenosis greater than 40% on contralateral vessel unless fractional flow reserve by CT (FFRct) >0.80
Vessel segment > 2 mm in diameter
Subject eligible for Dual Anti Platelet Therapy (DAPT

Exclusion Criteria

Significant bleeding risk or other contraindications against heparinization or DAPT
Known pregnancy
Life expectancy < 120 days
Patient unable to provide informed consent
Patients with CTO (Chronic Total Occlusion)
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