{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:51:19Z","timestamp":1789080679848,"version":"build-2803163510"},"reference-count":77,"publisher":"National Institute for Health and Care Research","issue":"37","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["13\/04\/108"],"award-info":[{"award-number":["13\/04\/108"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"\n Background<\/jats:title>\n Acute coronary syndrome is a common medical emergency. The optimal strategy to investigate patients who are at intermediate risk of acute coronary syndrome has not been fully determined.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the role of early computed tomography coronary angiography in the investigation and treatment of adults presenting with suspected acute coronary syndrome.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A prospective, multicentre, open, parallel-group randomised controlled trial with blinded end-point adjudication.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Thirty-seven hospitals in the UK.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Adults (aged \u2265\u200918 years) presenting to the emergency department, acute medicine services or cardiology department with suspected or provisionally diagnosed acute coronary syndrome and at least one of the following: (1) a prior history of coronary artery disease, (2) a cardiac troponin level >\u200999th centile and (3) an abnormal 12-lead electrocardiogram.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Early computed tomography coronary angiography in addition to standard care was compared with standard care alone. Participants were followed up for 1 year.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measure<\/jats:title>\n One-year all-cause death or subsequent type 1 (spontaneous) or type 4b (stent thrombosis) myocardial infarction, measured as the time to such event adjudicated by two cardiologists blinded to the computerised tomography coronary angiography (CTCA) arm. Cost-effectiveness was estimated as the lifetime incremental cost per quality-adjusted life-year gained.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Between 23 March 2015 and 27 June 2019, 1748 participants [mean age 62 years (standard deviation 13 years), 64% male, mean Global Registry Of Acute Coronary Events score 115 (standard deviation 35)] were randomised to receive early computed tomography coronary angiography (n<\/jats:italic>\u2009=\u2009877) or standard care alone (n<\/jats:italic>\u2009=\u2009871). The primary end point occurred in 51 (5.8%) participants randomised to receive computed tomography coronary angiography and 53 (6.1%) participants randomised to receive standard care (adjusted hazard ratio 0.91, 95% confidence interval 0.62 to 1.35; p<\/jats:italic>\u2009=\u20090.65). Computed tomography coronary angiography was associated with a reduced use of invasive coronary angiography (adjusted hazard ratio 0.81, 95% confidence interval 0.72 to 0.92; p<\/jats:italic>\u2009=\u20090.001) but no change in coronary revascularisation (adjusted hazard ratio 1.03, 95% confidence interval 0.87 to 1.21; p<\/jats:italic>\u2009=\u20090.76), acute coronary syndrome therapies (adjusted odds ratio 1.06, 95% confidence interval 0.85 to 1.32; p<\/jats:italic>\u2009=\u20090.63) or preventative therapies on discharge (adjusted odds ratio 1.07, 95% confidence interval 0.87 to 1.32; p<\/jats:italic>\u2009=\u20090.52). Early computed tomography coronary angiography was associated with longer hospitalisations (median increase 0.21 days, 95% confidence interval 0.05 to 0.40 days) and higher mean total health-care costs over 1 year (\u00a3561 more per patient) than standard care.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n The principal limitation of the trial was the slower than anticipated recruitment, leading to a revised sample size, and the requirement to compromise and accept a larger relative effect size estimate for the trial intervention.<\/jats:p>\n <\/jats:sec>\n \n Future work<\/jats:title>\n The potential role of computed tomography coronary angiography in selected patients with a low probability of obstructive coronary artery disease (intermediate or mildly elevated level of troponin) or who have limited access to invasive cardiac catheterisation facilities needs further prospective evaluation.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In patients with suspected or provisionally diagnosed acute coronary syndrome, computed tomography coronary angiography did not alter overall coronary therapeutic interventions or 1-year clinical outcomes, but it did increase the length of hospital stay and health-care costs. These findings do not support the routine use of early computed tomography coronary angiography in intermediate-risk patients with acute chest pain.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n This trial is registered as ISRCTN19102565 and Clinical Trials NCT02284191.<\/jats:p>\n <\/jats:sec>\n \n Funding<\/jats:title>\n This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment<\/jats:italic>; Vol. 26, No. 37. See the NIHR Journals Library website for further project information.<\/jats:p>\n <\/jats:sec>","DOI":"10.3310\/irwi5180","type":"journal-article","created":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T10:38:41Z","timestamp":1662374321000},"page":"1-114","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Early computed tomography coronary angiography in adults presenting with suspected acute coronary syndrome: the RAPID-CTCA RCT"],"prefix":"10.3310","volume":"26","clinical-trial-number":[{"clinical-trial-number":"isrctn19102565","registry":"10.18810\/isrctn","type":"results"},{"clinical-trial-number":"nct02284191","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1460-8327","authenticated-orcid":true,"given":"Alasdair J","family":"Gray","sequence":"first","affiliation":[{"name":"Usher Institute, University of Edinburgh, Edinburgh, 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