Stress Echocardiography and Heart Computed Tomography (CT) Scan in Emergency Department Patients With Chest Pain

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to determine whether stress echocardiography or computed tomography (CT) of the heart is better at diagnosing emergency room chest pain patients to select appropriate candidates for hospitalization and further work-up.

Official Title
-----------------
A Randomized Trial Comparing Coronary CT Angiography and Stress Echocardiography for Evaluation of Low-to-Intermediate Risk Emergency Department Chest Pain Patients

Conditions
-----------------
Chest Pain, Angina, Angina Pectoris, Coronary Artery Disease

Intervention / Treatment
-----------------
* Procedure: Stress Echocardiography
* Procedure: Coronary CT Angiography


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Presentation to the Emergency Department with chest pain Low-to-intermediate risk of coronary disease per Diamond-Forrester criteria Free of known coronary artery disease Exclusion Criteria: Inability to undergo both stress echo or coronary CT for any reason Contraindication to intravenous iodinated contrast Dysrhythmia precluding EKG gating Heart rate greater than 60 with contraindication to beta blockers Administration of beta blockers within the last 12 hours Known severe cardiac valvular disease or pulmonary hypertension Stress echocardiography, coronary CT or catheterization within the last 6 months

Ages Eligible for Study
-----------------
Minimum Age: 30 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Initial Stress Echocardiography<br> | Procedure: Stress Echocardiography<br>* Stress echocardiography will be performed once. Treadmill stress is default. Patients that cannot exercise will receive dobutamine stress with or without atropine. Definity intravenous contrast will be given when needed.<br>* Other names: SE;|
| Experimental: Initial Coronary CT Angiography<br> | Procedure: Coronary CT Angiography<br>* 64-detector, resting EKG-gated coronary CT angiography will be performed once. Patients with elevated heart rates will be given oral and/or intravenous metoprolol. Prospective gating with reduced tube current will be default. Retrospective gating with tube current modulation will be used in patients with higher heart rates.<br>* Other names: CCTA;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital admission |  | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Emergency Department length of stay |  | 30 days | 
| Hospital length of stay |  | 30 days | 
| Estimated cost of initial care |  | 30 days | 
| Repeat visits to the Emergency Department |  | 30 days and 1 year | 
| Death |  | 30 days and 1 year | 
| Non-fatal myocardial infarction |  | 30 days and 1 year | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
stress echocardiography, coronary ct angiography