Evidence map›Paper›PMID 25846248›Full record

Trial reportJournal of cardiovascular computed tomography

Potential for coronary CT angiography to tailor medical therapy beyond preventive guideline-based recommendations: insights from the ROMICAT I trial.

Amit Pursnani, Christopher L Schlett, Thomas Mayrhofer, Csilla Celeng, Pearl Zakroysky, Fabian Bamberg, John T Nagurney, Quynh A Truong, Udo Hoffmann

Abstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of cardiovascular computed tomography. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
2.2field-weighted citation impact, top 13% of its field
1 · What the graph read from it

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.

  1. Guideline
  2. Trial
  3. Review
  4. Article
  5. Article
  6. Review
  7. Chest pain: coronary CT in the ER.The British journal of radiology · 2016
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 2 countries.

Amit PursnaniCardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA; Cardiology Division, Evanston Hospital, Walgreen Building 3rd Floor, 2650 Ridge Ave, Evanston, IL 60201, USA. Electronic address: apursnani@northshore.org.
Christopher L SchlettDepartment of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
Thomas MayrhoferCardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA.
Csilla CelengCardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA.
Pearl ZakroyskyBiostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Fabian BambergDepartment of Clinical Radiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany.
John T NagurneyDepartment of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Quynh A TruongCardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, NY, USA.
Udo HoffmannCardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA.
Harvard University · USHeidelberg University · DELudwig-Maximilians-Universität München · DENewYork–Presbyterian Hospital · US

Funding

Cardiac MR and CT ResearchT32HL076136 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI NEILAN, TOMAS G · 2004 to 2019
$4.9M
Cardiac MDCT for Early Triage of Patients with ACSR01HL080053 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2006 to 2008
$1.5M
Cardiovascular Imaging in Ischemic Heart DiseaseK24HL113128 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2012 to 2020
$1.1M
NHLBI NIH HHS 5K24HL113128NHLBI NIH HHS K24 HL113128NHLBI NIH HHS R01 HL080053NHLBI NIH HHS T32 HL076136
6 · The paper itself

Abstract

backgroundCoronary CT angiography (CCTA) is used in the emergency department to rule out acute coronary syndrome in low-intermediate risk patients.

objectivesWe evaluated the potential of CCTA to tailor aspirin (ASA) and statin therapy in acute chest pain patients.

methodsWe included all patients in the ROMICAT I trial who underwent CCTA before admission. Results of CCTA were blinded to caretakers. We documented ASA and statin therapy at admission and discharge and determined change in medications during hospitalization, agreement of discharge medications with contemporaneous guidelines, and agreement with the presence and severity of coronary artery disease (CAD) as determined by CCTA.

resultsWe included 368 patients (53 ± 12 years; 61% male). Baseline medical therapy at presentation included 27% on ASA and 24% on statin. Most patients who qualified for secondary prevention were on ASA and statin therapy at discharge (95% and 80%, respectively), whereas among those qualifying for primary prevention therapy, only 59% of patients were on aspirin and 33% were on statin at discharge. Excluding secondary prevention patients, among those with CCTA-detected CAD, only 66/131 (50%) were on ASA at discharge and only 53/131 (40%) were on statin. Conversely, in those without CCTA-detected CAD, 54/156 (35%) were on ASA and 20/151 (13%) were on statin at discharge.

conclusionThere are significant discrepancies between discharge prescription of statin and ASA with the presence and extent of CAD. CCTA presents an efficient opportunity to tailor medical therapy to CAD in patients undergoing CCTA as part of their acute chest pain evaluation.

Indexed as

Emergency Service, HospitalTomography, X-Ray ComputedAcute Coronary SyndromeAdultAgedAspirinBostonCoronary AngiographyCoronary Artery DiseaseFemaleGuideline AdherenceHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPatient AdmissionAspirinHydroxymethylglutaryl-CoA Reductase InhibitorsPlatelet Aggregation InhibitorsAspirinCoronary artery diseaseCoronary CT angiographyGuidelinesPreventionStatin

Identifiers

PMID25846248
PMCPMC6849693
OpenAlexW2031562246

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.