Coronary CTA-guided strategy improves long-term outcomes in acute chest pain

An outpatient coronary CTA-guided strategy improved long-term outcomes in patients with acute-onset chest pain, according to results of the CATCH trial published in JACC: Cardiovascular Imaging.

Jesper J. Linde, MD, PhD, from the department of cardiology at Hvidovre University Hospital in Denmark, and colleagues designed the randomized controlled CATCH trial to compare the long-term effect of a coronary CTA-guided treatment strategy with standard care using functional tests in patients with recent acute chest pain, but normal ECGs and troponin values. Standard care was defined as bicycle exercise ECGs or myocardial perfusion imaging. Researchers noted that all coronary interventions were decided by the interventional cardiologist and were not influenced by the study investigators.

The randomly assigned sample consisted of 299 patients in the coronary CTA-guided strategy group and 301 patients in the standard-care group. Participants were followed for about 18 years (range, 16.8-20.1).

The primary endpoint was a combination of cardiac death, MI, hospitalization for unstable angina pectoris, late symptom-driven revascularizations and readmission for chest pain. In the coronary CTA-guided group, 30 patients (11%) reached the primary endpoint vs. 47 patients (16%) in the standard-care group (HR = 0.62; 95% CI, 0.4-0.98). The researchers reported major adverse cardiac events, including cardiac death, MI, hospitalization for unstable angina pectoris and late symptom-driven revascularization, in five patients in the coronary CTA-guided group and 14 in the standard-care group (HR = 0.36; 95% CI, 0.16-0.95).

The two groups did not differ in rates of cardiac death and MI (eight vs. two; P = .06).

Linde and colleagues noted that the coronary CTA-guided strategy was associated with improved detection of significant CAD and more index revascularizations. The researchers attributed the improved outcomes in the coronary CTA group to “more well-timed and appropriate coronary revascularization” and to treatment with platelet inhibitors.

The researchers concluded that implementing a coronary CTA-guided treatment strategy for patients with acute-onset chest pain in the outpatient setting could improve clinical outcomes. However, the researchers said because the observed clinical rate in the study was low, more research should be conducted to confirm the results, and analysis of long-term clinical outcomes after use of coronary CTA in the ED should also be analyzed in future studies. – by Tracey Romero

Disclosure: Linde reports receiving lecture fees from Toshiba Medical Systems. Please see the full study for a list of all other authors’ relevant financial disclosures.