Randomized Controlled Study of a Rapid “Rule Out” Strategy Using CT Coronary Angiogram Versus Traditional Care for Low-Risk ED Patients with Potential Acute Coronary Syndromes

This trial is organized by the American College of Radiology Imaging Network, and the principal investigator is Dr. Harold Litt at the University of Pennsylvania. Funded by the PA Department of Health and carried out by ACRIN PA Network institutions

Main Objective: The objective of this study is to estimate the rate of major cardiac events (AMI or cardiac death) within 30 days in participants randomized to CT coronary angiography (Group B) who were found not
to have significant coronary artery disease on CT coronary angiography. “Significant” coronary artery disease is defined as great than or equal to 50% stenosis of the left main, left anterior descending (LAD), left circumflex, right coronary artery (RCA), or their first order branches.

Participants: People 30 years and older who present to the ED with symptoms consistent with potential ACS, TIMI Risk Scores between 0 and 2, and ECG without acute ischemia.

Study Design Summary: A total of 1,365 participants will be recruited for this trial; 455 will be randomized to the traditional standard-of-care “rule out” treatment  and 910 will be randomized to the experimental “rule out” strategy of CT coronary angiography.  Accrual will be accomplished in 24 months.