Rapid Assessment of Potential Ischaemic Heart Disease With CTCA

INCLUSION CRITERIA

Patient ≥18 years with symptoms mandating investigation for suspected or confirmed ACS with at least one of:

• ECG abnormalities e.g. ST segment depression >0.5 mm;
• History of ischaemic heart disease (where the clinician assessing patient confirms history based on patient history or available records);
• Troponin elevation above the 99th centile of the normal reference range or increase in high sensitivity troponin meeting European Society of Cardiology criteria for 'rule-in' or myocardial infarction (NB troponin assays will vary from site to site; local laboratory reference standards will be used).

EXCLUSION CRITERIA

• Signs, symptoms, or investigations supporting high-risk ACS:
• ST elevation MI;
• ACS with signs or symptoms of acute heart failure or circulatory shock;
• Crescendo episodes of typical anginal pain;
• Marked or dynamic ECG changes e.g. ST depression of >3 mm
• Clinical team have scheduled early invasive coronary angiography on day of trial eligibility assessment.
• Patient inability to undergo CT:
• Severe renal failure (serum creatinine >250 µmol/L or estimated glomerular filtration rate <30 mL/min);
• Contrast allergy;
• Beta blocker intolerance (if no alternative heart rate limiting agent available/suitable) or allergy ;
• Inability to breath hold;
• Atrial fibrillation (where mean heart rate is anticipated to be greater than 75 beats per minute after beta blockade).
• Patient has had invasive coronary angiography or CTCA within last 2 years and the previous investigation revealed obstructive coronary artery disease, or patient had either investigation within the last 5 years and the result was normal.
• Previous recruitment to the trial;
• Known pregnancy or currently breast feeding;
• Inability to consent;
• Further investigation for ACS would not in the patient's interest, due to limited life expectancy, quality of life or functional status;
• Prisoners