Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients With Acute Chest Pain and Detectable to Elevated Troponin (CMR-IMPACT)
|Acute Coronary Syndrome Chest Pain||Procedure: Cardiac MRI Other: ACC/AHA Guideline adherent care|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Outcomes Assessor
Primary Purpose: Diagnostic
|Official Title:||Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients With Acute Chest Pain and Detectable to Elevated Troponin|
- Reduction in composite death, nonfatal myocardial infarction (MI), cardiac-related hospital readmissions, and cardiac-related Emergency Department (ED) visits. [ Time Frame: 5 years ]Test whether a CMR-guided strategy (versus invasive-based guideline-adherent strategy) reduces the composite of death, nonfatal MI, cardiac-related hospital readmission, and cardiac-related ED visits over time.
- Reduction in invasive angiography. [ Time Frame: 5 years ]Test whether a CMR-guided strategy (versus invasive-based guideline-adherent strategy) reduces invasive angiography.
- Reduction in coronary revascularization. [ Time Frame: 5 years ]Test whether a CMR-guided strategy (versus invasive-based guideline-adherent strategy) reduces coronary revascularization.
- Reduction in recurrent cardiac testing. [ Time Frame: 5 years ]Test whether a CMR-guided strategy (versus invasive-based guideline-adherent strategy) reduces recurrent cardiac testing.
|Actual Study Start Date:||September 2013|
|Estimated Study Completion Date:||May 2018|
|Estimated Primary Completion Date:||December 2017 (Final data collection date for primary outcome measure)|
Experimental: CMR-guided care
Participants in this group will receive a cardiac MRI
Procedure: Cardiac MRI
Participants in the CMR-guided care group will receive a cardiac MRI.
Active Comparator: Invasive-based guideline-adherent care
Participants will receive care adherent with current ACC/AHA guideline recommendations. ( ACC/AHA Guideline adherent care )
Other: ACC/AHA Guideline adherent care
Participants in the invasive-based guideline-adherent care group will receive care adherent with current American College of Cardiology / American Heart Association (ACC/AHA) guideline recommendations. ( ACC/AHA Guideline adherent care )
In the evaluation of patients with possible acute coronary syndrome, serum troponin measurement is a critical determinant of myocardial necrosis. The recent implementation of high-sensitivity troponin assays allows detection of lower levels of serum troponin than possible with less sensitive predecessors. As a result, 30% more patients are diagnosed with myocardial injury but the optimal management of these patients is unclear. Guidelines from the American Heart Association and American College of Cardiology recommend an invasive management strategy (Class 1a) but acknowledge that data supporting an invasive strategy were based on less sensitive troponin assays than those available today. Clinical trials of an invasive strategy in patients with detectable to minimally elevated troponin values demonstrate conflicting results. Observational data suggest aggressive medical therapy rather than increased use of revascularization drives improved outcomes in these patients. Meanwhile, these patients with minimally elevated serum troponin values have experienced a near doubling in the rate of invasive angiography. In short, it is uncertain whether patients with detectable to minimally elevated troponin results benefit from current invasive-based care strategies. As an alternative, cardiac magnetic resonance (CMR) imaging is highly accurate for detecting significant coronary disease and the need for coronary revascularization.
Objectives: The broad, long-term objective is to improve outcomes by optimizing healthcare delivery processes for patients with detectable to elevated serum troponin. To achieve this goal, we propose a clinical trial (n=312) involving emergency department patients with intermediate to high-risk chest pain and detectable to minimally elevated serum troponin within 6 hours of evaluation.
Methods: Participants will be randomized to one of two care strategies: a) invasive-based guideline-adherent strategy, or b) CMR-guided. Outcomes will be assessed over an average of 2.3 years. The specific aims of this proposal are 1) Test whether a CMR-guided strategy (versus invasive-based guideline-adherent strategy) reduces the composite of death, nonfatal myocardial infarction, and cardiac-related hospital readmission over the study duration, and 2) Test whether a CMR-guided strategy (versus invasive-based guideline-adherent strategy) reduces invasive angiography, coronary revascularization, recurrent cardiac testing, and cardiac-related emergency department visits.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01931852
|Contact: Stephanie Elliott, BSCRfirstname.lastname@example.org|
|United States, Michigan|
|William Beaumont Hospital||Recruiting|
|Royal Oak, Michigan, United States, 48073|
|Contact: Laura Stuecher, RN, BSN email@example.com|
|Principal Investigator: Carol Clark, MD|
|United States, Mississippi|
|University of Mississippi Medical Center||Recruiting|
|Jackson, Mississippi, United States, 39216|
|Contact: Margaret H Cruse 601-815-3008 firstname.lastname@example.org|
|Principal Investigator: Alan E Jones, MD|
|United States, North Carolina|
|Wake Forest Baptist Medical Center||Recruiting|
|Winston-Salem, North Carolina, United States, 27157|
|Contact: Erin Harper, MSHS, CCRP 336-716-2059 email@example.com|
|Principal Investigator: Chadwick D Miller, MD, MS|
|Sub-Investigator: L. Doug Case, PhD|
|Sub-Investigator: Craig Hamilton, PhD|
|Sub-Investigator: W. Gregory Hundley, MD|
|Sub-Investigator: Michael Kutcher, MD|
|Sub-Investigator: Simon Mahler, MD, MS|
|United States, Ohio|
|The Ohio State University Wexner Medical Center||Recruiting|
|Columbus, Ohio, United States, 43210|
|Contact: Michael Hill, RN, BSN 614-293-6185 firstname.lastname@example.org|
|Principal Investigator: Jeffrey Caterino, MD|
|Principal Investigator:||Chadwick Miller, MD, MS||WFBMC|