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Cited by 43Cardiac Imaging and DiagnosticsAcute Myocardial Infarction ResearchCoronary Interventions and Diagnostics

Design of the Rule Out Myocardial Ischemia/Infarction Using Computer Assisted Tomography: A multicenter randomized comparative effectiveness trial of cardiac computed tomography versus alternative triage strategies in patients with acute chest pain in the emergency department

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Hoffmann, Udo, Truong, Quynh A., Fleg, Jerome L., Goehler, Alexander, Gazelle, Scott, Wiviott, Stephen, Lee, Hang, Udelson, James E. +1 more·2012·American Heart Journal
DOI 10.1016/j.ahj.2012.01.028PMC PMC3736358
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Abstract

Although early cardiac computed tomographic angiography (CCTA) might improve the management of emergency department (ED) patients with acute chest pain, it could also result in increased testing, costs, and radiation exposure. ROMICAT II was a randomized comparative effectiveness trial enrolling patients 40 to 74 years old without known coronary artery disease who presented to the ED with chest pain but without ischemic electrocardiographic (ECG) changes or elevated initial troponin and who required further risk stratification. Overall, 1000 patients at 9 sites within the United States were randomized to either CCTA as the first diagnostic test following serial biomarkers or to standard of care, which included no testing or functional testing such as exercise ECG, stress radionuclide imaging, or stress echocardiography. Test results were provided to ED physicians, yet patient management was not driven by a study protocol in either arm. Data were collected on diagnostic testing, cardiac events, and cost of medical care for the index hospitalization and during the following 28 days. The primary end point was length of hospital stay. Secondary end points were cumulative radiation exposure, resource utilization, and costs of competing strategies. Tertiary end points were institutional, physician, and patient characteristics associated with primary and secondary outcomes. Rate of missed acute coronary syndrome within 28 days was the safety end point. The ROMICAT II will provide rigorous data on whether CCTA is more efficient than standard of care in the management of patients with acute chest pain at intermediate risk for acute coronary syndrome.

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  • Risk prediction was robust across multiple clinical scenarios, including a primary prevention asymptomatic setting with non-gated chest CT, and dedicated ECG-gated cardiac CT in stable and acute chest pain settings.

    “Risk prediction was robust across multiple clinical scenarios, including a primary prevention asymptomatic setting with non-gated chest CT (NLST)18, as well as dedicated ECG-gated cardiac CT in stable (PROMISE)19 and acute (ROMICAT-II)20 chest pain setting.”

    From Deep convolutional neural networks to predict cardiovascular risk from computed tomography (2021) · cites this paper as [20]

    The Patient population and Diagnostic testing sections identify ROMICAT II as an acute chest-pain trial using ECG-gated cardiac CT. But the Conclusion says the trial’s results were still expected; this design paper does not establish that risk prediction was robust in that setting. The NLST and PROMISE settings are attached to other citations, not this one. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In ROMICAT-II, there was a similar association between the deep learning calcium score and acute coronary syndrome at 28 days.

    “In 441 patients who had ECG-gated cardiac CT at nine sites, there was a similar association between the deep learning calcium score and acute coronary syndrome at 28 days (Fig. 2c)20.”

    From Deep convolutional neural networks to predict cardiovascular risk from computed tomography (2021) · cites this paper as [20]

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Authors
Hoffmann, U., Truong, Q. A., Fleg, J. L., Goehler, A., Gazelle, S., Wiviott, S., Lee, H., Udelson, J. E., & Schoenfeld, D.
Affiliations
  • Harvard University (US)
  • National Heart, Lung, and Blood Institute (US)
  • Brigham and Women's Hospital (US)
  • Tufts Medical Center (US)
Corresponding author
Hoffmann, Udo
ORCID
Venue
American Heart Journal
Publisher
Elsevier BV
Published
2012-03
Volume
163
Issue
3
Pages
330-338.e1
ISSN
0002-8703 (ISSN-L)
DOI
10.1016/j.ahj.2012.01.028
PMC
PMC3736358
OpenAlex
W1978419862
Cited by
43
References
0
Citations by year
2025: 3 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 6 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 6 · 2015: 7 · 2014: 3 · 2013: 4 · 2012: 3
FWCI
4.11
Type
journal article
Language
en
Open access
Licence
Locations
  • American Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (K23HL098370, L30HL093896, K24HL113128, U01HL092040, L30 HL093806)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
Keywords
acute chest pain, acute coronary syndrome, emergency department triage, intermediate-risk patients, radiation exposure, length of hospital stay, health care costs, resource utilization (health care), missed diagnosis
MeSH terms
Acute Disease, Adult, Aged, Chest Pain, Diagnosis, Differential, Electrocardiography, Emergency Service, Hospital, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Retrospective Studies, Sensitivity and Specificity, Tomography, X-Ray Computed, Triage, Reproducibility of Results

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