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Clinical Trial Details — Status: Terminated

Administrative data

NCT number NCT00538460
Other study ID # 2007-085
Secondary ID
Status Terminated
Phase N/A
First received October 1, 2007
Last updated February 26, 2010
Start date September 2007
Est. completion date April 2009

Study information

Verified date February 2010
Source William Beaumont Hospitals
Contact n/a
Is FDA regulated No
Health authority United States: Institutional Review Board
Study type Observational

Clinical Trial Summary

This study is designed to evaluate the effectiveness and measurable cost impact of stress cardiac MRI for non-invasive evaluation of intermediate lesions discovered on CCTA in low-to-intermediate risk patients admitted to the ED with suspected ACS. Our primary objective is to determine if the strategy of CTA + stress CMR will reduce the length of time in the ED required to establish a definitive diagnosis, compared to CTA + stress MPI.


Description:

Non-invasive evaluation of coronary anatomy via multi-slice computed tomography with coronary CT angiography (CCTA) has been shown to provide rapid and accurate non-invasive coronary angiography. Although CCTA can be rapidly and safely performed and despite improving our ability to image coronary arteries in this noninvasive fashion, the limitation of CCTA is lack of physiological information in intermediate lesions, i.e., if a patient has a blockage of 40-60% on CCTA in an artery, it is not possible to know if this is what causes symptoms in a patient. This limitation is currently being overcome by stress testing, commonly with perfusion imaging (nuclear stress test). However, disadvantages of nuclear stress testing include long testing times (usually > 4 hours) and use of radiation. Patients with intermediate/uninterpretable lesions on CCTA will be randomized to MPI or MRI.

The endpoints of the study are:

Primary outcome variables:

1. Length of ED stay until definitive diagnosis (time from ED triage until definitive diagnosis).

Secondary outcome variables will include:

1. Cost of care of an early diagnostic strategy utilizing stress CMR vs. standard care (costs incurred during index hospitalization and 30 day follow up period) in patients with intermediate lesions of CTA.

2. Accuracy of CTA + stress CMR in prediction of occurrence of major adverse cardiac events (MACE) during a 3 month follow-up period, compared to the standard care (CTA + stress/rest MPI): cardiac death, acute myocardial infarction, need for coronary artery revascularization, need for admission or treatment for documented CAD.


Recruitment information / eligibility

Status Terminated
Enrollment 1
Est. completion date April 2009
Est. primary completion date April 2009
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Both
Age group 18 Years and older
Eligibility Inclusion Criteria:

1. Patients with chest pain or other symptoms suggestive of acute cardiac ischemia.

2. Low risk TIMI risk score (ie. =3)

3. Able to provide informed consent

4. Age equal to or greater than 18 years.

Exclusion Criteria:

1. Electrocardiographic evidence of ischemia, including acute STEMI (ST elevation equal to or greater than 1mm in two or more leads), ST segment depression and/or T wave inversion (not known to be old), or attending physician clinical decision for immediate invasive evaluation.

2. Positive cardiac biomarkers (troponin, myoglobin, and/or creatinine phosphokinase MB fraction).

3. Presence of pre-existing CAD (prior myocardial infarction, prior angiographic evidence of significant CAD, prior coronary bypass surgery) or cardiomyopathy (ejection fraction < 45%)

4. Renal insufficiency (creatinine =1.6) or renal failure requiring dialysis.

5. Atrial fibrillation or other markedly irregular rhythm.

6. Inability or refusal to provide informed consent.

7. Psychological unsuitability or extreme claustrophobia.

8. Pregnancy or unknown pregnancy status.

9. Age less than 18 years.

10. Clinical instability as deemed by the attending physician; including cardiogenic shock, hypotension (systolic blood pressure < 90 mmHg), refractory hypertension (systolic blood pressure > 180 mmHg), sustained ventricular or atrial arrhythmia requiring intravenous medications.

11. Patients with known allergy to iodine or shellfish.

12. Inability to tolerate beta blockers, including those with COPD or asthma requiring maintenance inhaled bronchodilators or steroids, complete heart block, second-degree atrioventricular block.

13. Computed tomography imaging, or contrast administration, within the past 48 hours.

14. Use of Viagra or Cialis in the past 24 hours.

15. Patients with known allergy to gadolinium, x-ray dye, Persantine

16. Extreme claustrophobia.

17. Patients with metal implants that prevent MRI scanning

18. Patients with a body weight > 400 lbs

Study Design

Observational Model: Cohort, Time Perspective: Prospective


Related Conditions & MeSH terms


Locations

Country Name City State
United States William Beaumont Hospital Royal Oak Michigan

Sponsors (1)

Lead Sponsor Collaborator
William Beaumont Hospitals

Country where clinical trial is conducted

United States, 

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