Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark; Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark; Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
JACC Cardiovasc Imaging. 2015 Dec;8(12):1404-1413. doi: 10.1016/j.jcmg.2015.07.015. Epub 2015 Nov 11.
The aim of the CATCH (CArdiac cT in the treatment of acute CHest pain) trial was to investigate the long-term clinical impact of a coronary computed tomographic angiography (CTA)-guided treatment strategy in patients with recent acute-onset chest pain compared to standard care.
The prognostic implications of a coronary CTA-guided treatment strategy have not been compared in a randomized fashion to standard care in patients referred for acute-onset chest pain.
Patients with acute chest pain but normal electrocardiograms and troponin values were randomized to treatment guided by either coronary CTA or standard care (bicycle exercise electrocardiogram or myocardial perfusion imaging). In the coronary CTA-guided group, a functional test was included in cases of nondiagnostic coronary CTA images or coronary stenoses of borderline severity. The primary endpoint was a composite of cardiac death, myocardial infarction (MI), hospitalization for unstable angina pectoris (UAP), late symptom-driven revascularizations, and readmission for chest pain.
We randomized 299 patients to coronary CTA-guided strategy and 301 to standard care. After inclusion, 24 patients withdrew their consent. The median (interquartile range) follow-up duration was 18.7 (range 16.8 to 20.1) months. In the coronary CTA-guided group, 30 patients (11%) had a primary endpoint versus 47 patients (16%) in the standard care group (p = 0.04; hazard ratio [HR]: 0.62 [95% confidence interval: 0.40 to 0.98]). A major adverse cardiac event (cardiac death, MI, hospitalization for UAP, and late symptom-driven revascularization) was observed in 5 patients (2 MIs, 3 UAPs) in the coronary CTA-guided group versus 14 patients (1 cardiac death, 7 MIs, 5 UAPs, 1 late symptom-driven revascularization) in the standard care group (p = 0.04; HR: 0.36 [95% CI: 0.16 to 0.95]). Differences in cardiac death and MI (8 vs. 2) were insignificant (p = 0.06).
A coronary CTA-guided treatment strategy appears to improve clinical outcome in patients with recent acute-onset chest pain and normal electrocardiograms and troponin values compared to standard care with a functional test. (Cardiac-CT in the Treatment of Acute Chest Pain [CATCH]; NCT01534000).
CATCH（心脏 CT 在急性胸痛治疗中的应用）试验的目的是研究与标准治疗相比，在近期急性发作胸痛患者中，基于冠状动脉计算机断层扫描血管造影（CTA）的治疗策略的长期临床影响。
在因急性发作胸痛而接受治疗的患者中，尚未以随机方式比较基于冠状动脉 CTA 的治疗策略与标准治疗（运动心电图或心肌灌注成像）在预后方面的差异。
将急性胸痛但心电图和肌钙蛋白值正常的患者随机分为接受基于冠状动脉 CTA 或标准治疗的治疗（如果冠状动脉 CTA 图像不明确或存在临界严重程度的冠状动脉狭窄，则进行功能试验）。在冠状动脉 CTA 指导组中，对于非诊断性冠状动脉 CTA 图像或边界狭窄的冠状动脉狭窄患者，包括功能试验。主要终点是心脏死亡、心肌梗死（MI）、不稳定型心绞痛（UAP）住院、晚期症状驱动的血运重建和因胸痛再入院的复合终点。
我们将 299 名患者随机分配至冠状动脉 CTA 指导策略组，301 名患者分配至标准治疗组。纳入后，有 24 名患者撤回了同意。中位（四分位间距）随访时间为 18.7（16.8 至 20.1）个月。在冠状动脉 CTA 指导组中，有 30 名患者（11%）发生了主要终点事件，而标准治疗组中有 47 名患者（16%）（p=0.04；风险比[HR]：0.62[95%置信区间：0.40 至 0.98]）。冠状动脉 CTA 指导组有 5 名患者（2 例 MI，3 例 UAP）发生主要不良心脏事件（心脏死亡、MI、UAP 住院和晚期症状驱动的血运重建），而标准治疗组有 14 名患者（1 例心脏死亡、7 例 MI、5 例 UAP、1 例晚期症状驱动的血运重建）（p=0.04；HR：0.36[95%CI：0.16 至 0.95]）。心脏死亡和 MI 发生率的差异无统计学意义（8 比 2）（p=0.06）。
与标准治疗加功能试验相比，在近期急性发作胸痛且心电图和肌钙蛋白值正常的患者中，基于冠状动脉 CTA 的治疗策略似乎可改善临床结局。（心脏 CT 在急性胸痛治疗中的应用[CATCH]；NCT01534000）。
