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This month’s update is by the team from the Emergency Medicine Research group in Cambridge. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.
The papers are ranked as:
Worth a peek: interesting, but not yet ready for prime time.
Head turner: new concepts.
Game changer: this paper could/should change practice.
Early CT coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial
Rating: head turner
This UK-based multicentre randomised controlled trial included medium-risk patients with suspected acute coronary syndrome, to determine whether an early CT of their coronary arteries (CTCAs) would reduce the risk of death or myocardial infarction within the next 12 months. Medium risk was defined as having known coronary artery disease (CAD), high troponins or abnormal ECGs.
The rationale for the study was the increasing number of hospital admissions for chest pain in recent years as a result of changing demographics and more sensitive troponin assays. The authors speculated that an early CTCA might allow for shorter length of stay (LOS), fewer complications and lower healthcare costs than an invasive coronary angiography. Previous studies in low-risk patients showed CTCA not to add this benefit, since a large proportion of patients could be discharged safely without invasive angiography anyway. In the medium-risk group though, the balance may be different.
The study enrolled more than 1700 participants, randomising half to standard care and half to standard care plus CTCA.1 CTCA revealed obstructive CAD in 47% of the patients but had no significant effect on the rates of revascularisation or medication changes. Death or myocardial infarction, the primary endpoint, occurred in 5.8% of patients in the CT arm and 6.1% in the standard care arm (95% CI 0.62% to 1.35%)—a non-significant …
Twitter @liam126, @danw1310, @dradrianboyle
Contributors The top five papers were selected as a group. Summaries were wrote by LB, DPW, SR and TA. VN and AAB reviewed the summaries, provided feedback and made edits to revisions.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.