CompletedHeart, Stroke & BloodDigestion, Kidneys & Other Organs
The RAPID-CTCA trial (Rapid Assessment of Potential Ischaemic Heart Disease with CTCA) 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
Recipient organisationUniversity of EdinburghSource-published name: The University of Edinburgh
Funding£1.8M
PeriodJan 2015 — Sept 2020
In plain English
AI plain-English summary
Every year, thousands of patients with chest pain are admitted to hospital for observation, but many do not actually have a heart attack. This trial tested whether giving patients a CT coronary angiogram (CTCA) early in the emergency department could improve diagnosis and treatment compared to standard care. The problem is that current assessment methods—ECG changes and troponin blood tests—can miss some cases of coronary artery disease or lead to unnecessary admissions. The trial recruited 1,725 patients across roughly 35 NHS hospitals, all with symptoms or test results suggesting a possible acute coronary syndrome. Patients were randomly assigned to either early CTCA or usual care, and followed for 12 months. If early CTCA proves more effective at identifying who truly needs intervention—such as stents or medication—it could reduce unnecessary hospital stays and invasive procedures, while catching more patients who would otherwise be sent home with undiagnosed disease. This would directly affect emergency medicine workflows and cardiology resource allocation, quietly improving how the NHS triages one of its most common and costly presentations.
View original technical description
DESIGN: Open parallel group randomised controlled trial of early computed tomography coronary angiography (CTCA) in Emergency Department (ED) and Medical Assessment unit patients presenting with suspected/confirmed acute coronary syndrome (ACS). SETTING: ~35 EDs, radiology, cardiology and acute medical services in tertiary/district general NHS hospitals. TARGET POPULATION: Inclusion criteria: Patients greater than or equal to 18 years with symptoms mandating investigation for suspected or confirmed ACS with at least one of: 1. ECG abnormalities e.g. ST segment depression >0.5 mm; 2. History of ischaemic heart disease (where the clinician assessing patient confirms history based on patient history or available records); 3. Troponin elevation above the 99th centile of the normal reference range or increase in high sensitivity troponin meeting European Society of Cardiology criteria for ‘rule-in’ of myocardial infarction. Exclusion criteria: 1. Signs, symptoms, or investigations supporting high-risk ACS: ST elevation MI; ACS with signs or symptoms of acute heart failure or circulatory shock; Crescendo episodes of typical anginal pain; Marked or dynamic ECG changes e.g. ST depression of >3 mm; Clinical team have scheduled early invasive coronary angiography on day of trial eligibility assessment. 2. Patient inability to undergo CT: Severe renal failure (serum creatinine >250 µmol/L or estimated glomerular filtration rate <30 mL/min); Contrast allergy; Beta blocker intolerance (if no alternative heart rate limiting agent available/suitable) or allergy; Inability to breath hold; Atrial fibrillation (where mean heart rate is anticipated to be greater than 75 beats per minute after beta blockade). 3. Patient has had invasive coronary angiography or CTCA within last 2 years and the previous investigation revealed obstructive coronary artery disease, or patient had either investigation within the last 5 years and the result was normal. 4. Previous recruitment to the trial; 5. Known pregnancy or currently breast feeding; 6. Inability to consent; 7. Further investigation for ACS would not in the patient’s interest, due to limited life expectancy, quality of life or functional status; 8. Prisoners SAMPLE SIZE: 1725 participants. PROJECT TIMETABLE: Trial set up: May 2014-Oct 2014 Site Set up: Oct 2014-Feb 2017 Recruitment: Mar 2015-Jun 2019 12-Month Follow up: Mar 2016-Jun 2020 Analysis and reporting: Jul 2020-Sep 2020 Trial Closure: Sep 2020
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