Evidence map›Paper›PMID 27006119›Full record

Trial reportJournal of the American Heart Association2016

Coronary CT Angiography Versus Standard Emergency Department Evaluation for Acute Chest Pain and Diabetic Patients: Is There Benefit With Early Coronary CT Angiography? Results of the Randomized Comparative Effectiveness ROMICAT II Trial.

Quynh A Truong, Joshua Schulman-Marcus, Pearl Zakroysky, Eric T Chou, John T Nagurney, Jerome L Fleg, David A Schoenfeld, James E Udelson, Udo Hoffmann, Pamela K Woodard

Registry-linked trialOpen access · goldAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American Heart Association, 2016. 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 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
1.7field-weighted citation impact, top 17% 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.

NCT01084239 phase3completednot on this map

Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography

TypeinterventionalSponsorMassachusetts General HospitalRan2010 to 2012Enrolled1,000ConditionsAcute Coronary Syndrome, Myocardial Infarction, Unstable Angina PectorisArmsCardiac Computed Tomography
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 22 citations in OpenAlex.

  1. Trial
  2. Review
  3. Article
  4. Article
  5. Article
  6. Review
  7. Article
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

10 authors at 7 institutions in 1 country.

Quynh A TruongDalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY.
Joshua Schulman-MarcusDalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY.
Pearl ZakroyskyMassachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, MA.
Eric T ChouKaiser Permanente Fontana Medical Center, Fontana, CA.
John T NagurneyEmergency Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Jerome L FlegDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD.
David A SchoenfeldMassachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, MA.
James E UdelsonDivision of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA.
Udo HoffmannCardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Pamela K WoodardMallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO woodardp@mir.wustl.edu.
Harvard University · USCornell University · USKaiser Permanente Fontana Medical Center · USMallinckrodt (United States) · USNational Heart Lung and Blood Institute · USNewYork–Presbyterian Hospital · USTufts Medical Center · US

Funding

ROMICAT II - CCC - Lead ApplicationU01HL092040 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI HOFFMANN, UDO · 2009 to 2013
$4.9M
Rule-Out Myocardial Infarction Using Computed Assisted Tomography-ROMICATII,DCCU01HL092022 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI SCHOENFELD, DAVID ALAN · 2009 to 2012
$1.2M
Computed Tomography to Predict Response to Cardiac Resynchronization TherapyK23HL098370 · NHLBI · WEILL MEDICAL COLL OF CORNELL UNIV · PI TRUONG, QUYNH A. · 2010 to 2014
$816k
NHLBI NIH HHS K23HL098370NHLBI NIH HHS L30HL093896NHLBI NIH HHS U01HL092022NHLBI NIH HHS U01HL092040
6 · The paper itself

Abstract

backgroundCardiac computed tomography angiography (CCTA) reduces emergency department length of stay compared with standard evaluation in patients with low- and intermediate-risk acute chest pain. Whether diabetic patients have similar benefits is unknown. METHODS AND

resultsIn this prespecified analysis of the Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT II) multicenter trial, we randomized 1000 patients (17% diabetic) with symptoms suggestive of acute coronary syndrome to CCTA or standard evaluation. The rate of acute coronary syndrome was 8% in both diabetic and nondiabetic patients (P=1.0). Length of stay was unaffected by the CCTA strategy for diabetic patients (23.9 versus 27.2 hours, P=0.86) but was reduced for nondiabetic patients compared with standard evaluation (8.4 versus 26.5 hours, P<0.0001; P interaction=0.004). CCTA resulted in 3-fold more direct emergency department discharge in both groups (each P≤0.0001, P interaction=0.27). No difference in hospital admissions was seen between the 2 strategies in diabetic and nondiabetic patients (P interaction=0.09). Both groups had more downstream testing and higher radiation doses with CCTA, but these were highest in diabetic patients (all P interaction≤0.04). Diabetic patients had fewer normal CCTAs than nondiabetic patients (32% versus 50%, P=0.003) and similar normalcy rates with standard evaluation (P=0.70). Notably, 66% of diabetic patients had no or mild stenosis by CCTA with short length of stay comparable to that of nondiabetic patients (P=0.34), whereas those with >50% stenosis had a high prevalence of acute coronary syndrome, invasive coronary angiography, and revascularization.

conclusionsKnowledge of coronary anatomy with CCTA is beneficial for diabetic patients and can discriminate between lower risk patients with no or little coronary artery disease who can be discharged immediately and higher risk patients with moderate to severe disease who warrant further workup. CLINICAL

trial registrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT01084239.

Indexed as

Cardiology Service, HospitalEmergency Service, HospitalTomography, X-Ray ComputedAcute Coronary SyndromeAdultAgedAngina PectorisCoronary AngiographyCoronary Artery DiseaseDiabetic AngiopathiesFemaleHumansLength of StayMaleMiddle AgedPatient Dischargeacute coronary syndromecardiac computed tomographychest pain diagnosisdiabetes mellitusemergency department

Identifiers

PMID27006119
PMCPMC4943281
OpenAlexW2302769399

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

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.