Coronary Artery Disease Management Using Multislice Computed Tomography and Magnetic Resonance Imaging (CAD-Man)

• ClinicalTrials.gov Identifier: NCT00844220
• Recruitment Status: Completed
• First Posted: February 16, 2009
• Last Update Posted: March 15, 2021
• Sponsor: Charite University, Berlin, Germany
• Collaborators: University Hospital Muenster; Charite University, Berlin, Eva Schönenberger, MD; University of Freiburg
• Information provided by (Responsible Party): Marc Dewey, Charite University, Berlin, Germany

Study Description

Brief Summary:

The primary objective of this study is to analyze the clinical value of a therapeutic management strategy based on the results of coronary CT angiography and functional MRI. The clinical value of CT and MRI will be analyzed in patients with suspected coronary artery disease.

Condition or disease	Intervention/treatment	Phase
Coronary Artery Disease	Procedure: CT/MR; Procedure: Catheterization	Not Applicable

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 340 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Diagnostic
• Official Title: Coronary Artery Disease Management Using Multislice Computed Tomography and Magnetic Resonance Imaging
• Actual Study Start Date: February 18, 2009
• Actual Primary Completion Date: September 2015
• Actual Study Completion Date: October 2018

Arms and Interventions

Arm	Intervention/treatment
Experimental: CT/MR; CT/MRI-directed clinical management strategy	Procedure: CT/MR; CT/MRI-directed clinical management strategy
Active Comparator: Catheterization; Standard clinical management	Procedure: Catheterization; Standard clinical management directed by conventional coronary angiography

Outcome Measures

Primary Outcome Measures :

1. Complications [ Time Frame: during or up to 2 days after procedures ]
   Death, stroke, and myocardial infarction and moderate to severe groin hematoma, groin pain, infections, allergies, thromboses, and arteriovenous fistula or other complications (if prolonging the in-hospital stay significantly by at least 24 hours).

Secondary Outcome Measures :

1. Hard Cardiovascular Events [ Time Frame: Follow-up 3 (36-60 Months) ]
   Composite endpoint: The most important secondary outcome will be hard cardiovascular events at final follow-up (3 years). These hard events include: cardiac and noncardiac death (death from any cause), stroke, and myocardial infarction. These hard events are considered as major adverse cardiovascular events.
2. Comparison of Contrast Induced Nephropathy [ Time Frame: Follow-up 1 (6-12 Months), Follow-up 2 (12-24 Months), Follow-up 3 (36-60 Months) ]
   To compare contrast-induced nephropathy (CIN) defined as increase in creatinine by 25% or 0.5 mg/dl from baseline at the measurements obtained 18 to 24 and/or 46 to 50 hours after the initial procedures as part of standard safety parameters performed at our institution. In addition, CIN will also be assessed during the follow-ups.
3. Comparison of Comparison of Soft Cardiovascular Events [ Time Frame: Follow-up 3 (36-60, Months) ]
   To compare soft cardiovascular events (unstable angina pectoris, re-revascularization, and first revascularization at least 2 months after randomization, according to the results of Ladenheim et al. J Am Coll Cardiol 1986, at final follow-up.
4. Comparison of In-Hospital Stay [ Time Frame: Up to 24 hours after the end of the in-hospital stay. ]
   to compare the in-hospital stay time and overall length of stay.
5. Quality of Life Analysis [ Time Frame: Follow-up 1 (6-12 Months), Follow-up 2 (12-24 Months), Follow-up 3 (36-60 Months) ]
   To analyze the change in quality of life (QALY) in both groups (prior to the tests and at follow-up) using the SF-12 and the EuroQuol as general measurement tools and the MacNew questionnaire as disease-specific questionnaire.
6. Confounding Effects of Nutrition, Physical Activity, and Depression [ Time Frame: Follow-up 1 (6-12 Months), Follow-up 2 (12-24 Months), Follow-up 3 (36-60 Months) ]
   To analyze the effect and potentially confounding effect of nutrition, physical activity (using the Freiburg questionnaire), and depression (assessed with the HADS questionnaire) in the two groups.
7. Comparison of Cost-effectiveness [ Time Frame: Follow-up 3 (36-60 Months) ]
   To compare cost-effectiveness in both groups using the primary and secondary efficacy data, the QALY data, and cost data derived from the trial.
8. Comparison of Patient Preference [ Time Frame: 24 hours after last procedure related to computed tomography or conventional coronary angiography ]
   To analyze patient preference and satisfaction with the therapeutic management strategies with a focus on the comfort during the imaging tests.
9. Comparison of the Amount of Contrast Agent [ Time Frame: 10 minutes after the examinations. ]
   Comparison of the amount of contrast agent
10. Comparison of the Amount of Radiation Exposure [ Time Frame: Comparison of the amount of radiation exposure ]
    10 minutes after computed tomography or conventional coronary angiography
11. Analysis of Image Quality [ Time Frame: Up to 24 hours after the end of computed tomography ]
    To analyze which image quality in multislice computed coronary angiography would be required to directly reliably triage patients to coronary artery bypass grafting.
12. Analysis of Correlation and Agreement About the Stenosis Diameter Between Multislice Computed Coronary Angiography and Conventional Coronary Angiography [ Time Frame: Up to 24 hours after the end of computed tomography ]
    To analyze the correlation and agreement between multislice computed coronary angiography and conventional coronary angiography (using quantitative analysis) for estimation of the percent diameter stenosis in patients who underwent both tests.
13. Comparison of Biological Effects of Radiation Exposure [ Time Frame: Z1) before exam, (Z2) 60 min after end of exam, (Z3) 18-24h after exam ]
    To compare the biological effects of radiation exposure of ionizing radiation, measured by DNA double-strand breaks in lymphocytes, of CT and conventional coronary angiography themselves and in the two randomization groups (approval by ethics board for this substudy with start of first patient analyzed on September, 15, 2009). Blood samples are taken for double-strand break analysis.

Eligibility Criteria

• Ages Eligible for Study: 30 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Suspected coronary artery disease and planned conventional coronary angiography based on atypical angina pectoris

Exclusion Criteria:

• Known coronary artery disease
• ST elevation
• Age below 30 years
• Women of child-bearing potential without a negative pregnancy test
• Inclusion in another study
• Heart rate above 70 beats per min and contraindications to beta blockers
• Atrial fibrillation or uncontrolled tachyarrhythmia, or advanced atrioventricular block
• Inability to hold the breath for 10 s

Contacts and Locations

Locations

Germany

Charité

Berlin, Germany, 10117

Sponsors and Collaborators

Charite University, Berlin, Germany

University Hospital Muenster

Charite University, Berlin, Eva Schönenberger, MD

University of Freiburg

Investigators

• Principal Investigator: Marc Dewey, MD, PhD; Charite University, Berlin, Germany

More Information

Additional Information:

CAD-Man results 

Publications of Results:

Dewey M, Rief M, Martus P, Kendziora B, Feger S, Dreger H, Priem S, Knebel F, Bohm M, Schlattmann P, Hamm B, Schonenberger E, Laule M, Zimmermann E. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial. BMJ. 2016 Oct 24;355:i5441. doi: 10.1136/bmj.i5441. Erratum In: BMJ. 2016 Nov 29;355:i6420.

Bosserdt M, Feger S, Rief M, Preuss D, Ibes P, Martus P, Kofoed KF, Laule M, Perez I, Dewey M. Performing Computed Tomography Instead of Invasive Coronary Angiography: Sex Effects in Patients With Suspected CAD. JACC Cardiovasc Imaging. 2020 Mar;13(3):888-889. doi: 10.1016/j.jcmg.2019.10.014. Epub 2019 Dec 18. No abstract available.

Other Publications:

Dewey M, de Vries H, de Vries L, Haas D, Leidecker C. The present and future of cardiac CT in research and clinical practice: moderated discussion and scientific debate with representatives from the four main vendors. Rofo. 2010 Apr;182(4):313-21. doi: 10.1055/s-0029-1245195. Epub 2010 Mar 16.

Zimmermann E, Dewey M. Whole-heart 320-row computed tomography: reduction of radiation dose via prior coronary calcium scanning. Rofo. 2011 Jan;183(1):54-9. doi: 10.1055/s-0029-1245629. Epub 2010 Aug 19.

Dewey M, Zimmermann E, Deissenrieder F, Laule M, Dubel HP, Schlattmann P, Knebel F, Rutsch W, Hamm B. Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation. 2009 Sep 8;120(10):867-75. doi: 10.1161/CIRCULATIONAHA.109.859280. Epub 2009 Aug 24.

Dewey M. Coronary CT versus MR angiography: pro CT--the role of CT angiography. Radiology. 2011 Feb;258(2):329-39. doi: 10.1148/radiol.10100161. No abstract available.

Schoenhagen P, Nagel E. Noninvasive assessment of coronary artery disease anatomy, physiology, and clinical outcome. JACC Cardiovasc Imaging. 2011 Jan;4(1):62-4. doi: 10.1016/j.jcmg.2010.11.002. No abstract available.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Bosserdt M, Martus P, Tauber R, Dreger H, Dewey M, Schonenberger E; CAD-Man Study Group Investigators. Serum creatinine baseline fluctuation and acute kidney injury after intravenous or intra-arterial contrast agent administration-an intraindividual comparison as part of a randomized controlled trial. Nephrol Dial Transplant. 2022 May 25;37(6):1191-1194. doi: 10.1093/ndt/gfac013. No abstract available.

Schonenberger E, Martus P, Bosserdt M, Zimmermann E, Tauber R, Laule M, Dewey M. Kidney Injury after Intravenous versus Intra-arterial Contrast Agent in Patients Suspected of Having Coronary Artery Disease: A Randomized Trial. Radiology. 2019 Sep;292(3):664-672. doi: 10.1148/radiol.2019182220. Epub 2019 Jul 2.

• Responsible Party: Marc Dewey, Professor, Charite University, Berlin, Germany
• ClinicalTrials.gov Identifier: NCT00844220
• Other Study ID Numbers: EA1/080/08
• First Posted: February 16, 2009
• Last Update Posted: March 15, 2021
• Last Verified: March 2021

Keywords provided by Marc Dewey, Charite University, Berlin, Germany:

Suspected coronary artery disease

Additional relevant MeSH terms:

Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Heart Diseases; Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases