Role of Cardiac CT in Rapid Access Chest Pain Clinics (RADICAL)

Summary

Heart disease remains the most common cause of death in the UK. Chest pain is often the first presenting symptom in patients with heart disease, and may be a warning signal prior to a heart attack or death. The diagnosis based on symptoms alone however is unreliable and further testing is almost always necessary.

Rapid access chest pain clinics (RACPCs) are able to expedite the assessment of such patients. The principal investigation used is an exercise stress electrocardiogram (s-ECG). Although simple, cheap, and convenient, the s-ECG is often inaccurate; missing the diagnosis or falsely suggesting the diagnosis. This can happen in as many as 25% of patients, resulting in a delay in treatment or unnecessary further investigation.

CT Angiography (CTA) is a novel non-invasive technique where the coronary arteries can be visualised by Computerised Tomography. In previous studies it shows a high degree of correlation with invasive angiography, with a high accuracy for the diagnosis of obstructive coronary artery disease. However, the technique is relatively new, and its full role is yet to be defined in the clinical setting of a chest pain clinic. The investigators do not at present have any information as to whether it is able to speed up the diagnosis, reduce the need for other tests, and therefore also costs.

In this trial, the investigators aim to examine the accuracy and cost effectiveness of CTA in patients with suspected cardiac chest pain presenting to a chest pain clinic, when compared to the more established techniques like s-ECG, myocardial perfusion scanning and coronary angiography. The study will enable us to establish the optimal and most cost effective strategy for investigation of patients presenting to chest pain clinics.

Conditions

• Coronary Artery Disease

Interventions

OTHER

CT coronary angiography

CT coronary angiography: This allows two distinct assessments of the coronary arteries to be made: * coronary calcium scan, which is a 30 second, low-radiation scan that allows reproducible quantification of the amount of calcium in the coronary arteries to be made. * contrast enhanced CT coronary angiogram. This is a quick, non-invasive scan to assess the patency of coronary arteries.

OTHER

Standard of Care

The management of patients in this group is according to the NHS protocol and is not altered by their participation in the trial. The choice of diagnostic investigation for CAD is determined by the patient's clinical scenario and the availability of different diagnostic modalities in the recruiting hospital.

Sponsors & Collaborators

• Wellington Hospital

  collaborator OTHER_GOV

• Barnet and Chase Farm Hospitals NHS Trust

  collaborator OTHER

• Chase Farm Hospital

  collaborator OTHER

• Royal Free Hospital NHS Foundation Trust

  collaborator OTHER

• AJAY YERRAMASU

  lead OTHER_GOV

Principal Investigators

• Deven Patel, MBBch, FRCP · Barnet Hospital, Wellhouse Lane, Barnet, UK

Study Design

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

40 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2009-02-28

Primary Completion

2011-12-31

Completion

2011-12-31

Countries

• United Kingdom

Study Locations