Trial reportBMJ (Clinical research ed.)2021
Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial.
Trial report in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 44 papers, 3 of them syntheses that pooled 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.
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.
The Role of Early CT Coronary Angiography in the Evaluation, Intervention and Outcome of Patients Presenting to the Emergency Department With Suspected or Confirmed Acute Coronary Syndrome.
ECG-less Coronary Computed Tomography Angiography in the Management of Patients Presenting With High-troponin Chest Pain
Who cites it
44 citing papers in PubMed, 3 syntheses or guidelines pooled it, 97 citations in OpenAlex.
- Pooled it
- Representation of Older Adults and Women in Randomized Trials of Noninvasive Imaging for Chest Pain.Circulation. Cardiovascular imaging · 2025Pooled it
- 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
- Cardiac Magnetic Resonance Imaging Versus Invasive-Based Strategies in Patients With Chest Pain and Detectable to Mildly Elevated Serum Troponin: A Randomized Clinical Trial.Circulation. Cardiovascular imaging · 2023Trial
- Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT).Heart (British Cardiac Society) · 2022Trial
- Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial.European heart journal. Acute cardiovascular care · 2022Trial
- Characteristics and outcomes of patients undergoing coronary computed tomography angiography for suspected acute coronary syndrome in the emergency department.The international journal of cardiovascular imaging · 2026Article
- Redefining NSTE-ACS risk assessment: The synergistic power of CT-enhanced GRACE 2.0 score for advanced prognosis.The international journal of cardiovascular imaging · 2026Article
- Review
- Sex-specific differences in the prognostic value of ischemic pre-hospital ECGs.Frontiers in cardiovascular medicine · 2026Article
- Article
- Multimodality Non-Invasive Imaging Approach in Acute Coronary Syndrome: Diagnostic and Prognostic Assessment.Current cardiology reports · 2025Review
- Development and validation of deep learning model for detection of obstructive coronary artery disease in patients with acute chest pain: a multi-center study.La Radiologia medica · 2025Article
- Acute coronary syndromes: mechanisms, challenges, and new opportunities.European heart journal · 2025Review
- Coronary computed tomography angiography in suspected acute coronary syndrome patients with intermediate high-sensitivity cardiac troponin I levels: a valuable diagnostic tool.Quantitative imaging in medicine and surgery · 2025Article
- Serum LncRNA PSMB8-AS1 as a novel biomarker for predicting acute coronary syndrome.Scientific reports · 2025Article
- Benchmarking Photon-Counting Computed Tomography Angiography Against Invasive Assessment of Coronary Stenosis: Implications for Severely Calcified Coronaries.JACC. Cardiovascular imaging · 2025Article
- Review
- Coronary CT Angiography in the Emergency Department: State of the Art and Future Perspectives.Journal of cardiovascular development and disease · 2025Review
- Avoiding invasive angiography in non-ST-elevation MI patients: are coronary CT angiography and FFR-CT the answer?EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
16 authors at 8 institutions in 1 country.
Funding
Abstract
objectivesTo establish if the use of early computed tomography (CT) coronary angiography improves one year clinical outcomes in patients presenting to the emergency department with acute chest pain and at intermediate risk of acute coronary syndrome and subsequent clinical events.
designRandomised controlled trial.
setting37 hospitals in the UK.
participantsAdults with suspected or a provisional diagnosis of acute coronary syndrome and one or more of previous coronary heart disease, raised levels of cardiac troponin, or abnormal electrocardiogram.
interventionsEarly CT coronary angiography and standard of care compared with standard of care only.
main outcome measuresPrimary endpoint was all cause death or subsequent type 1 or 4b myocardial infarction at one year.
resultsBetween 23 March 2015 and 27 June 2019, 1748 participants (mean age 62 years (standard deviation 13), 64% men, mean global registry of acute coronary events (GRACE) score 115 (standard deviation 35)) were randomised to receive early CT coronary angiography (n=877) or standard of care only (n=871). Median time from randomisation to CT coronary angiography was 4.2 (interquartile range 1.6-21.6) hours. The primary endpoint occurred in 51 (5.8%) participants randomised to CT coronary angiography and 53 (6.1%) participants who received standard of care only (adjusted hazard ratio 0.91 (95% confidence interval 0.62 to 1.35), P=0.65). Invasive coronary angiography was performed in 474 (54.0%) participants randomised to CT coronary angiography and 530 (60.8%) participants who received standard of care only (adjusted hazard ratio 0.81 (0.72 to 0.92), P=0.001). There were no overall differences in coronary revascularisation, use of drug treatment for acute coronary syndrome, or subsequent preventive treatments between the two groups. Early CT coronary angiography was associated with a slightly longer time in hospital (median increase 0.21 (95% confidence interval 0.05 to 0.40) days from a median hospital stay of 2.0 to 2.2 days).
conclusionsIn intermediate risk patients with acute chest pain and suspected acute coronary syndrome, early CT coronary angiography did not alter overall coronary therapeutic interventions or one year clinical outcomes, but reduced rates of invasive angiography while modestly increasing length of hospital stay. These findings do not support the routine use of early CT coronary angiography in intermediate risk patients with acute chest pain and suspected acute coronary syndrome.
trial registrationISRCTN19102565, NCT02284191.
Indexed as
Identifiers
What OpenQuestion holds
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.