Trial reportCirculation. Cardiovascular imaging2015
Use of coronary artery calcium scanning beyond coronary computed tomographic angiography in the emergency department evaluation for acute chest pain: the ROMICAT II trial.
Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
In one paragraph
Trial report in Circulation. Cardiovascular imaging, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01084239 (Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography), which is not on this map. Cited by 17 papers, 1 of them a synthesis that pooled it.
0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 1 pooled it
6.0field-weighted citation impact, top 3% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 50 citations in OpenAlex.
- 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee.Journal of the American College of Cardiology · 2022Guideline
- Prognostic Value of Coronary Artery Calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain).Circulation · 2017Trial
- Impact of coronary artery calcium scores on cardiovascular risk and preventive therapies: A systematic review and meta-analysis.Global cardiology science & practice · 2025Review
- The Value of Coronary Computed Tomography Angiography in Patients with a High Calcium Score.The journal of Tehran Heart Center · 2023Article
- Prognostic value of CT-derived coronary artery disease characteristics varies by ASCVD risk: insights from the PROMISE trial.European radiology · 2023Article
- Predicting Significant Coronary Obstruction in a Population with Suspected Coronary Disease and Absence of Coronary Calcium: CORE-64 / CORE320 Studies.Arquivos brasileiros de cardiologia · 2023Article
- The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain.Journal of cardiovascular development and disease · 2022Article
- Calculating Risk vs Detecting Disease: Changing the Cardiovascular Prevention Paradigm Using Cardiac CT.JACC. Cardiovascular imaging · 2022Article
- Cardiac CT angiography in current practice: An American society for preventive cardiology clinical practice statementAmerican journal of preventive cardiology · 2022Article
- Review
- What Is the Power of Nonzero?Radiology. Cardiothoracic imaging · 2019Article
- Coronary Computed Tomography Angiography Improving Outcomes in Patients with Chest Pain.Current cardiovascular imaging reports · 2019Article
- Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography.Arquivos brasileiros de cardiologia · 2018Article
- Noninvasive Coronary Plaque Imaging.Journal of atherosclerosis and thrombosis · 2018Review
- Identification of coronary artery calcification can optimize risk stratification in patients with acute chest pain.International journal of cardiology · 2017Observational
- Role of Coronary Calcium for Risk Stratification and Prognostication.Current treatment options in cardiovascular medicine · 2017Review
- Chest pain: coronary CT in the ER.The British journal of radiology · 2016Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 6 institutions in 1 country.
Amit PursnaniFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
Eric T ChouFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
Pearl ZakroyskyFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
Roderick C DeañoFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
Wilfred S MamuyaFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
Pamela K WoodardFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
John T NagurneyFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
Jerome L FlegFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
Hang LeeFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
David SchoenfeldFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
James E UdelsonFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
Udo HoffmannFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.).
Quynh A TruongFrom the Cardiac MR PET CT Program, Division of Cardiology, Department of Radiology (A.P., W.S.M., U.H.), Emergency Department (J.T.N.), and Biostatistics Center (P.Z., H.L., D.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Cardiology Division, Kaiser Permanente Fontana Medical Center, CA (E.T.C.); Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, New York (R.C.D., Q.A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (P.K.W.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.). qat9001@med.cornell.edu.
Mallinckrodt (United States) · USCornell University · USNewYork–Presbyterian Hospital · USKaiser Permanente Fontana Medical Center · USNational Heart Lung and Blood Institute · USPresbyterian Hospital · US
Funding
ROMICAT II - CCC - Lead ApplicationU01HL092040 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2009 to 2013
$4.9MCardiac MR and CT ResearchT32HL076136 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI NEILAN, TOMAS G · 2004 to 2019
$4.9MRule-Out Myocardial Infarction Using Computed Assisted Tomography-ROMICATII,DCCU01HL092022 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI SCHOENFELD, DAVID ALAN · 2009 to 2012
$1.2MCardiovascular Imaging in Ischemic Heart DiseaseK24HL113128 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2012 to 2020
$1.1MComputed Tomography to Predict Response to Cardiac Resynchronization TherapyK23HL098370 · NHLBI · WEILL MEDICAL COLL OF CORNELL UNIV · PI TRUONG, QUYNH A. · 2010 to 2014
$816kNHLBI NIH HHS K23 HL098370NHLBI NIH HHS K23HL098370NHLBI NIH HHS K24 HL113128NHLBI NIH HHS L30 HL093806NHLBI NIH HHS L30HL093896NHLBI NIH HHS T32 HL076136NHLBI NIH HHS U01 HL092022NHLBI NIH HHS U01HL092022NHLBI NIH HHS U01 HL092040NHLBI NIH HHS U01HL092040
Abstract
backgroundWhether a coronary artery calcium (CAC) scan provides added value to coronary computed tomographic angiography (CCTA) in emergency department patients with acute chest pain remains unsettled. We sought to determine the value of CAC scan in patients with acute chest pain undergoing CCTA. METHODS AND
resultsIn the multicenter Rule Out Myocardial Infarction using Computer-Assisted Tomography (ROMICAT) II trial, we enrolled low-intermediate risk emergency department patients with symptoms suggesting acute coronary syndrome (ACS). In this prespecified subanalysis of 473 patients (54±8 years, 53% men) who underwent both CAC scanning and CCTA, the ACS rate was 8%. Overall, 53% of patients had CAC=0 of whom 2 (0.8%) developed ACS, whereas 7% had CAC>400 with 49% whom developed ACS. C-statistic of CAC>0 was 0.76, whereas that using the optimal cut point of CAC≥22 was 0.81. Continuous CAC score had lower discriminatory capacity than CCTA (c-statistic, 0.86 versus 0.92; P=0.03). Compared with CCTA alone, there was no benefit combining CAC score with CCTA (c-statistic, 0.93; P=0.88) or with selective CCTA strategies after initial CAC>0 or optimal cut point CAC≥22 (P≥0.09). Mean radiation dose from CAC acquisition was 1.4±0.7 mSv. Higher CAC scores resulted in more nondiagnostic CCTA studies although the majority remained interpretable.
conclusionsIn emergency department patients with acute chest pain, CAC score does not provide incremental value beyond CCTA for ACS diagnosis. CAC=0 does not exclude ACS, nor a high CAC score preclude interpretation of CCTA in most patients. Thus, CAC results should not influence the decision to proceed with CCTA, and the decision to perform a CAC scan should be balanced with the additional radiation exposure required. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01084239.
Indexed as
Acute Coronary SyndromeAgedAngina PectorisCoronary AngiographyCoronary Artery DiseaseCoronary VesselsEmergency Service, HospitalFemaleHumansMaleMiddle AgedMultidetector Computed TomographyPredictive Value of TestsRadiation DosageSeverity of Illness IndexUnited Statesacute coronary syndromehospital emergency servicemultidetector-row computed tomography
Identifiers
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Registered trials
NCT01084239ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.