Comparison of Low-radiation Dose CT Angiography With Invasive Coronary Angiography in Stable Coronary Disease

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01476579
Recruitment Status : Active, not recruiting
First Posted : November 22, 2011
Last Update Posted : June 17, 2016
University of Tromso
Information provided by (Responsible Party):
University Hospital of North Norway

Brief Summary:
This study is evaluating the performance of modern CT coronar angiography with low radiation technique compared to conventional invasive coronar angiography. The patients recruited will already be accepted for invasive coronary angiography based on clinical presentation, ECG and biochemical parameters. An "all-comers" design to avoid selection bias and no additional B-blockers will be used prior to CT angiography. The hypothesis is that it is possible to rule out significant coronary artery disease with sensitivity > 95 % and negative predictive value > 95 % with very low radiation doses.

Condition or disease Intervention/treatment Phase
Coronary Artery Disease Device: Cardiac Computer Tomography Phase 4

Detailed Description:

Conventional invasive coronary angiography (CICA) is associated with few but serious complications. It is time consuming for the patient and incur costs to the health institution due to the post-procedure observation needed. Coronary computer tomography angiography (CCTA) is a good alternative to CICA to rule out coronary artery disease (CAD). Moderate to excellent sensitivity and negative predictive values have been reported with 64-slice CT angiography. The main ethical problem has been the radiation doses given to the patient during CT angiography which was high >10 millisievert(mSv). With 265 or higher slice CT machines and radiation dose reduction techniques, it is possible to evaluate coronary anatomy with radiation doses below 1 mSv. Heart rate reduction with B-blockers is in most cases not necessary with new generation CT machines but is recommended in guidelines.

800 patients already accepted for CICA based on clinical information will be scheduled to undergo CCTA prior to invasive coronary angiography. Coronary anatomy will be described according to American Heart Association (AHA) classification with 17 segment analysis. The main purpose of the study is to achieve high sensitivity and high negative predictive value with CT angiography. Radiation doses in relation to gender and body mass index (BMI) will be monitored. In addition we will measure coronary calcification (Agatson score) and look at any association to the Vitamin D and calcium metabolism. Patient reported quality of life evaluation with validated questionnaires and long term follow up (5 and 10 years) regarding clinical endpoints.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 769 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Diagnostic Accuracy of New Generation Low-dose CT Coronary Angiography
Study Start Date : January 2012
Actual Primary Completion Date : December 2012
Estimated Study Completion Date : January 2022

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Non-invasive CT coronary angiography
This study is evaluating diagnostic accuracy of non-invasive CT coronary angiography with invasive coronary angiography.
Device: Cardiac Computer Tomography
Compare Cardiac CT with reference standard wich is conventional invasive coronary angiography.

Primary Outcome Measures :
  1. Sensitivity and specificity [ Time Frame: 24 hours ]
    The results from the CT coronary angiography will be compared with the results from the conventional invasive coronary angiography which in this respect is considered the "gold standard". The sensitivity and specificity for the CT angiography regarding detection of significant coronary stenosis (ie more than 50 % lumen narrowing with the angiographic result as reference) and for revascularisation will be calculated separately.

Secondary Outcome Measures :
  1. Change in quality of life and symptom score [ Time Frame: 6 months, 1 and 3 years ]
    Change from baseline in quality of life and symptoms as measured with SF-12, HADS og SEATTLE will be assessed both for patients with and without significant coronary pathology with postal questionnaires at 6 months, 1 and 3 years after the CT angiography

  2. Coronary calcium score impact on pretest coronary risk scoring and prognosis [ Time Frame: 24 hours, 5 and 10 years ]
    The change in pretest probability for detection of significant stenosis and revascularisation by calcium score will be calculated in addition to prediction of 5 and 10 year fatal and non fatal cardiovascular events.

  3. Vitamin D and other novel cardiovascular risk factors [ Time Frame: 24 hours, 5 and 10 years ]
    The association of vitamin D levels (25OHD) and Single Nucleotide Polymorphism (SNP) related to vitamin D and calcium metabolism to presence of coronary plaques and their calcium content will be analysed as well as risk of fatal and non fatal coronary events. When events are registered other new novel risk markers detected in the Tromso Study will be measured in a nested case control design.

  4. Real life radiation risk with new CT scanners and conventional invasive angiography [ Time Frame: 24 hours ]
    The radiation doses will be measured independent of supplier software for both procedures and compared. Impact of risk factors on radiation dosage and image quality will be determined.

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Ages Eligible for Study:   30 Years to 90 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

1. 800 Patients who are scheduled to undergo conventional invasive coronary angiogram will be recruited at the University hospital of North Norway, Tromsø.

Exclusion Criteria:

  1. Acute coronary syndrome with positive high sensitive troponin.
  2. Renal failure with glomerular filtration rate (GFR) < 30
  3. Contraindication to contrast medium
  4. Symptomatic Tachycardia >110 or bradycardia < 40
  5. Pregnancy
  6. Lack of informed consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01476579

University Hospital of North Norway
Tromsø, Norway, 9038
Sponsors and Collaborators
University Hospital of North Norway
University of Tromso
Principal Investigator: AMJID IQBAL, MD, PhD University Hospital of North Norway

Responsible Party: University Hospital of North Norway Identifier: NCT01476579     History of Changes
Other Study ID Numbers: 2011/123
First Posted: November 22, 2011    Key Record Dates
Last Update Posted: June 17, 2016
Last Verified: June 2016

Keywords provided by University Hospital of North Norway:
Coronary CT
Tomography, X-Ray Computed
Coronary angiography

Additional relevant MeSH terms:
Coronary Artery Disease
Myocardial Ischemia
Coronary Disease
Heart Diseases
Cardiovascular Diseases
Arterial Occlusive Diseases
Vascular Diseases