- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01542086
Comparison of the Cost-Effectiveness of Coronary CT Angiography Versus Myocardial SPECT in Patients With Intermediate Risk of Coronary Heart Disease (CARE-CCTA)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Coronary heart disease (CHD) is the leading cause of heart failure in Westernized countries and accounts for one of the most common cause of mortality in Korea. More importantly, the nation's health cost is being more and more spent on the treatment of CHD. Therefore, selecting the right patients for intervention is becoming more and more important.
The diagnosis and treatment strategy of CHD relies on both anatomic and functional imaging. First, there should be a significant narrowing of a segment of the coronary artery and second, there must also be evidence of ischemia due to the lesion. As a consequence of the recent, rapid development and distribution of the high-resolution computed tomography (CT), physicians are referring more and more patients for anatomic imaging of the coronary vasculature with coronary CT angiography (CCTA). CCTA has the advantage of imaging the coronary arteries noninvasively that is nearly as exact as conventional, invasive coronary angiography. However, CCTA also has the possibility of overdiagnosing CHD, especially intermediate lesions. This can be important give the recent outcome of the FAME study demonstrating the inferiority of relying on only anatomic diagnosis.
In contrast, myocardial single photon emission computed tomography (SPECT) has the advantage of imaging ischemia more accurately, since it is more of a functional imaging than an anatomical imaging. However, the sensitivity and specificity is less than 80%, which means that a total of 20% of the patients can be false-negative or false-positive. In addition, although it can demonstrate ischemia, it cannot provide where and how much the coronary artery is stenotic.
Recently, van Werkhoven and Bax demonstrated that CCTA and myocardial SPECT may be complementary. The study showed that patients with both abnormal CCTA and myocardial SPECT results tend to be worse in terms of event-free survival than patients with either alone. However, the nation's cost may be too burdenful if the patients are charged with both tests together and thus, it is more critical to give information on the cost-effectiveness of both of these tests.
In this study, we aim to compare the cost-effectiveness of CCTA and myocardial SPECT in patients with intermediate pre-test probability of CHD. To this end, patients with intermediate pre-test probability of CHD will be randomized 1:1 to either CCTA and myocardial SPECT. The patients will be analyzed for cost and also, for outcome.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Seoul, Korea, Republic of, 110-744
- Recruiting
- Seoul National University Hospital
-
Principal Investigator:
- Hyun-Joo Lee, MD
-
Principal Investigator:
- Hae Ok Jung, MD
-
Principal Investigator:
- Sang-Chol Lee, MD
-
Principal Investigator:
- Hyuk-Jae Chang, MD
-
Principal Investigator:
- Dae-Hee Kim, MD
-
Principal Investigator:
- Goo Young Cho, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Subject must be ≥30 years old and ≤80 years old.
- Subject is able to verbally confirm understandings of risks, benefits and diagnostic alternatives of receiving CCTA or SPECT.
- He/she or his/her legally authorized representative provides written informed consent prior to any study related procedure.
- Subject must have intermediate probability of coronary artery disease as assessed by the appropriate criteria written below.
Exclusion Criteria:
- The patient has been previously diagnosed as having significant coronary artery disease previously (≥50% stenosis) or has previously been intervened for significant coronary artery disease (PCI or CABG).
- The patient has prior history of myocardial infarction.
- The patient has high pre-test probability of having coronary artery disease.
- The patient has history of impaired renal function, i.e. CRF or ARF.
- The patient has allergy to iodinated contrast agents.
- Female of childbearing potential, unless a recent pregnancy test is negative, who possibly plan to become pregnant any time after enrollment into this study.
- Non-cardiac co-morbid conditions are present with life expectancy <1 year or that may result in protocol non-compliance (per site investigator's medical judgment), i.e. malignancy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: DIAGNOSTIC
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Myocardial SPECT
|
|
EXPERIMENTAL: 64-channel coronary CT angiography (CCTA)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Cost-effectiveness (cost-utility)
Time Frame: 1 Year after initial enrollment
|
1 Year after initial enrollment
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ESTIMATE)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- H-1105-050-361
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Chest Pain
-
Clinical Locomotion ScienceOdense University Hospital; University of Southern Denmark; The County of Funen... and other collaboratorsCompletedUndiagnosed Chest Pain | Musculoskeletal Chest Pain | Non-cardiac Chest PainDenmark
-
Academisch Medisch Centrum - Universiteit van Amsterdam...TerminatedFunctional Chest PainNetherlands
-
Ataturk UniversityCompletedPain, Acute | Pain, ChestTurkey
-
Queen's UniversityCompletedChest Pain Atypical SyndromeCanada
-
Cairo UniversityActive, not recruitingNonspecific Cardiac Chest PainEgypt
-
Universiti Sains MalaysiaCompletedNon Cardiac Chest PainMalaysia
-
Milton S. Hershey Medical CenterCompletedNoncardiac Chest Pain (NCCP)United States
-
Fayoum University HospitalCompleted
-
University of Texas Southwestern Medical CenterCompletedAcute Chest PainUnited States
-
Massachusetts General HospitalBracco Diagnostics, IncCompletedChest Pain SyndromeUnited States
Clinical Trials on Myocardial SPECT
-
Charite University, Berlin, GermanyCompleted
-
Institut de cancérologie Strasbourg EuropeRecruiting
-
St. Louis UniversityAstellas Pharma US, Inc.WithdrawnCoronary Artery DiseaseUnited States
-
Denver Health and Hospital AuthorityGeneral ElectricCompletedChest Pain | Symptomatic Ischemic EquivalentUnited States
-
Assistance Publique Hopitaux De MarseilleCompletedCoronary Artery LesionFrance
-
Hospices Civils de LyonTerminatedCoronary Heart DiseaseFrance
-
University Hospital, CaenCompleted
-
Baptist Health South FloridaGE HealthcareCompleted
-
Ottawa Heart Institute Research CorporationCanadian Institutes of Health Research (CIHR)CompletedCoronary Artery DiseaseCanada
-
University Hospital, Basel, SwitzerlandSiemens Corporation, Corporate TechnologyRecruiting