Use of Coronary Artery @entity460 Scanning Beyond Coronary Computed Tomographic Angiography in the Emergency Department Evaluation for Acute XXXX : The ROMICAT II Trial.

@entity1 @entity1187 @entity662 @entity2073 @entity460
BACKGROUND: Whether a coronary artery @entity460 (CAC) scan provides added value to coronary computed tomographic angiography (CCTA) in emergency department @entity1 with acute @entity662 remains unsettled. We sought to determine the value of CAC scan in @entity1 with acute @entity662 undergoing CCTA. METHODS AND RESULTS: In the multicenter Rule Out Myocardial Infarction using Computer-Assisted Tomography (ROMICAT) II trial, we enrolled low-intermediate risk emergency department @entity1 with symptoms suggesting @entity1187 ( @entity1187 ). In this prespecified subanalysis of 473 @entity1 (54  8 years, 53% @entity1 ) who underwent both CAC scanning and CCTA, the @entity1187 rate was 8%. Overall, 53% of @entity1 had CAC=0 of whom 2 (0.8%) developed @entity1187 , whereas 7% had CAC>400 with 49% whom developed @entity1187 . C-statistic of CAC>0 was 0.76, whereas that using the optimal cut point of CAC>= 22 was 0.81. Continuous CAC score had lower discriminatory capacity than CCTA (c-statistic, 0.86 versus 0.92; P=0.03). Compared with CCTA alone, there was no benefit combining CAC score with CCTA (c-statistic, 0.93; P=0.88) or with selective CCTA strategies after initial CAC>0 or optimal cut point CAC>= 22 (P>= 0.09). Mean radiation dose from CAC acquisition was 1.4  0.7 @entity2073 . Higher CAC scores resulted in more nondiagnostic CCTA studies although the majority remained interpretable. CONCLUSIONS: In emergency department @entity1 with acute @entity662 , CAC score does not provide incremental value beyond CCTA for @entity1187 diagnosis. CAC=0 does not exclude @entity1187 , nor a high CAC score preclude interpretation of CCTA in most @entity1 . Thus, CAC results should not influence the decision to proceed with CCTA, and the decision to perform a CAC scan should be balanced with the additional radiation exposure required. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01084239.
