Risk Stratification of Non ST Elevation ACS With Computed Tomographic Angiography (REACT)

Study Overview
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Brief Summary
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The purpose of this project is to examine the effectiveness of computed tomographic angiography (CTA) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). People who are hospitalized with this situation often require an angiogram to assess the heart and its arteries. Recent advancements in technology have enabled CTA to clearly define coronary artery anatomy with great accuracy and to guide treatment strategies in select patient populations. We are investigating that CTA may be used, as an alternative to conventional angiograms, for the risk stratification of patients with high risk NSTE-ACS. Patients eligible for the study will be high risk NSTE-ACS and awaiting an angiogram. Enrolled patients will undergo CTA prior to the angiogram. With each CTA the patient will be injected with a small dose of an X-ray dye and will be asked to lie still on the scanning bed for a period of 5-10 minutes.

Official Title
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Risk Stratification of Non ST Elevation ACS With Computed Tomographic Angiography (REACT)

Conditions
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Acute Coronary Syndrome, Non-ST-Elevation Myocardial Infarction, Unstable Angina

Intervention / Treatment
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* Procedure: Computed Tomographic Angiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: High risk ACS Angina [accelerating pattern or prolonged episode (> 20 minutes) or recurrent episode at rest or with minimal effort within preceding 24 hours]; and (13) Elevated Troponin - T (≥0.1 ug/L) or ECG changes consistent with ischemia [ST depression ≥ 0.1 mV, transient ST segment elevation ≥ 0.1 mV (< 20 minutes)]) (11;13) Planned conventional invasive coronary angiography Exclusion Criteria: Age < 18 years or lack of consent Renal Insufficiency (GFR < 60 ml/min) Allergy to contrast agent Refractory angina requiring urgent/emergent coronary angiography (as per treating physician) Contraindication to radiation exposure (e.g. pregnancy) Uncontrolled HR Previous CABG or PCI/Stent Atrial fibrillation, frequent atrial or ventricular ectopy (> 1 / minute) Unable to perform 20 second breath-hold

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Computed Tomographic Angiography|CT scan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Operating Characteristics of CTA |  | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To compare the accuracy of CTA to CICA in predicting the mode of revascularization (PCI versus CABG) in NSTE-ACS patients. |  | 1 month | 
| To determine the number of avoidable CICA (i.e. those accurately designated to medical therapy or surgery with CTA). |  | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ACS, Unstable Angina, NSTEMI