이 페이지는 자동 번역되었으며 번역의 정확성을 보장하지 않습니다. 참조하십시오 영문판 원본 텍스트의 경우.

CCTA-guided Ultraselective Invasive Coronary Angiography

2021년 7월 31일 업데이트: Lokien van Nunen, Catharina Ziekenhuis Eindhoven

Coronary Computed Tomography Angiography Guidance in Invasive Coronary Angiography; a Prospective Registry Study

Coronary artery disease (CAD) is the leading cause of death in adults in the United States.[1] In the latest guidelines of the European Society of Cardiology anatomical non-invasive imaging by coronary computed tomography angiography (CCTA) plays an important role in the diagnosis of the presence of CAD in patients without a history of CAD and a low to intermediate likelihood.[2] CCTA provides high accuracy for the detection of coronary artery disease by visualizing the coronary artery lumen using an intravenous contrast agent.[3] However to determine the hemodynamical significance of CCTA-identified stenosis, invasive coronary angiography (ICA) with or without functional testing is still required. [4] During the ICA as per protocol the complete coronary artery system is visualized again. In patients with abnormalities on CCTA in only one coronary artery, i.e. only the left coronary artery (LCA) or the right coronary artery (RCA), the ICA procedure might be simplified by 'ultraselectively' visualizing only the coronary artery of interest and refraining from angiographic visualization of the contralateral coronary artery without abnormalities on CCTA (with an excellent negative predictive value of 95-99%).[5-7] Such an ultraselective strategy might reduce procedure time, usage of catheters, complication risk and the amount of contrast agent and radiation exposure.

A recent retrospective study in three hospitals in the Netherlands showed CCTA to be extremely accurate in predicting a normal contralateral coronary artery in patients with coronary artery disease limited to the left or right coronary artery. Therefore, a CCTA-guided ultraselective ICA approach would have been safe and feasible and would have led to a considerable decrease in procedure time and radiation exposure.

However, the analysis was hampered by the retrospective design. The potential benefits in salvage of procedure time and radiation exposure might be overestimated and it turned out to be impossible to measure the effects on contrast use, catheter use and procedure costs. Moreover, in the retrospective study only a small portion of the study population had abnormalities in the right coronary artery, thereby questioning the results of this study to safely be extrapolated to this category of patients with abnormalities in the RCA.

This dual-center prospective registry study is designed to answer these remaining questions and to further investigate the potential benefit of an ultraselective ICA approach.

연구 개요

상태

모병

상세 설명

Study design & patient population

The study is a dual-center prospective registry in two hospitals in the Netherlands. All patients eligible for participation in this registry are aged 18-80 years old and undergoing invasive coronary angiography because of abnormalities found on CCTA in either the left or right coronary artery and no or minimal stenosis (CAD-RADS 0-1; 0-24% stenosis) in the contralateral coronary artery.

Patients will be asked for written informed consent to register their clinical data in an anonymized database. The period between CCTA and ICA may not exceed 90 days, in order to prevent possible aggravation of coronary artery disease between both examinations.

Clinical characteristics (age, gender, risk factors, relevant medical history) and CCTA data will be included in the database. All procedural characteristics and findings of the invasive coronary angiography procedure will be logged, including access site, procedural planning (which coronary artery to be visualized first), procedure duration, amount and type of catheters used, amount of radiation exposure and contrast volume, procedural findings, type of coronary intervention (if applicable), and complications. Procedure duration is defined as the time needed for the diagnostic part of the ICA procedure, possible further functional invasive testing and/or percutaneous coronary intervention is excluded. ICA data will be compared to the CCTA data on a per-patient level. No further follow-up is planned after the invasive coronary angiography with regards to participating in this registry.

Informed consent

If patients provide informed consent, the data will be registered in an anonymized database. Patients can withdraw from this study at any time at their own request, or they may be withdrawn at the discretion of the investigator for behavioral, or administrative reasons. The reason(s) for discontinuation will be documented and may include: the subject voluntarily withdraws from registry.

Since the patients will not be subjected to any additional procedures, rules or behavior and the data will be anonymized, we believe this research design does not fall under the scope of the Medical Research Involving Human Subjects Act (WMO).

Database and data protection

Data will be stored anonymized in an online database and will only be accessible to the involved researchers. Personal data will comply to the Dutch Personal Data Protection Act. Site investigators will only be able to add patients from their own site, and will only be able to see patients from their own site. Data generated will be encoded and a separate patient identification log will be created for each site, and stored at each site separately. The key to the code will be available to specific site investigators only. There will be at least one study coordinator that has access to all records of all sites. In the future data from other centers could be included into the database using this similar pattern to ensure data protection.

연구 유형

관찰

등록 (예상)

250

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 연락처

연구 연락처 백업

연구 장소

    • North-Brabant
      • Eindhoven, North-Brabant, 네덜란드, 5623 EJ
        • 모병
        • Catharina Hospital
        • 연락하다:
        • 수석 연구원:
          • Lokien X van Nunen, MD PhD

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

18년 (성인, 고령자)

건강한 자원 봉사자를 받아들입니다

해당 없음

연구 대상 성별

모두

샘플링 방법

비확률 샘플

연구 인구

The prospected study population is 250 patients. This study population allows for enough statistical power to answer all endpoints as described above. Due to the fact that only a few patients with abnormalities on the CCTA limited to the RCA were analyzed in the retrospective study, we defined that at least 15% of the patient population must consist of patients with an abnormal RCA on CCTA. In order to reach this distribution, inclusion of patients with abnormalities in the LCA on CCTA may be halted in favor of patients with abnormalities in the RCA.

설명

Inclusion Criteria:

  • Patients undergoing invasive coronary angiography because of abnormalities found on CCTA in either the left or right coronary artery and no or minimal stenosis (CAD-RADS 0-1; 0-24% stenosis) in the contralateral coronary artery within 90 days.

Exclusion Criteria:

  • Refusal of informed consent
  • Abnormalities in both coronary arteries on CCTA
  • Prior PCI
  • Prior coronary artery bypass grafting (CABG)
  • Major allergy to iodinated contrast agent
  • Inability to provide informed consent, and/or known pregnancy.

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

코호트 및 개입

그룹/코호트
Study population
All patients eligible for participation in this registry are aged 18-80 years old and undergoing invasive coronary angiography because of abnormalities found on CCTA in either the left or right coronary artery and no or minimal stenosis (CAD-RADS 0-1; 0-24% stenosis) in the contralateral coronary artery. Patients will be asked for written informed consent to register their clinical data in an anonymized database. The period between CCTA and ICA may not exceed 90 days, in order to prevent possible aggravation of coronary artery disease between both examinations.

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
Accuracy of CCTA
기간: At the end of the invasive coronary angiography procedure, an average of 25 minutes
The accuracy of CCTA to defer invasive angiography of the contralateral coronary artery, in patients with abnormalities on CCTA limited to either the left or right coronary artery and a normal or minimal abnormal contralateral artery (defined as CAD-RADS 0-1; 0-24% stenosis)
At the end of the invasive coronary angiography procedure, an average of 25 minutes

2차 결과 측정

결과 측정
측정값 설명
기간
Reduction in procedure time
기간: At the end of the invasive coronary angiography procedure, an average of 25 minutes.
The time to visualize the contralateral coronary artery without abnormalities on CCTA will be considered as superfluous and is therefore a potential benefit of an ultraselective ICA.
At the end of the invasive coronary angiography procedure, an average of 25 minutes.
Reduction in radiation
기간: At the end of the invasive coronary angiography procedure, an average of 25 minutes
The radiation used to to visualize the contralateral coronary artery without abnormalities on CCTA will will be considered as superfluous and is therefore a potential benefit of an ultraselective ICA.
At the end of the invasive coronary angiography procedure, an average of 25 minutes
Reduction in contrast volume
기간: At the end of the invasive coronary angiography procedure, an average of 25 minutes
The contrast volume used to to visualize the contralateral coronary artery without abnormalities on CCTA will be considered as superfluous and is therefore a potential benefit of an ultraselective ICA.
At the end of the invasive coronary angiography procedure, an average of 25 minutes
Reduction in catheter usage
기간: At the end of the invasive coronary angiography procedure, an average of 25 minutes
The amount of catheter used to visualize the contralateral coronary artery without abnormalities on CCTA will be considered as superfluous and is therefore a potential benefit of an ultraselective ICA.
At the end of the invasive coronary angiography procedure, an average of 25 minutes

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

간행물 및 유용한 링크

연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.

일반 간행물

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작 (실제)

2021년 7월 1일

기본 완료 (예상)

2022년 12월 31일

연구 완료 (예상)

2022년 12월 31일

연구 등록 날짜

최초 제출

2021년 5월 21일

QC 기준을 충족하는 최초 제출

2021년 5월 25일

처음 게시됨 (실제)

2021년 6월 1일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)

2021년 8월 3일

QC 기준을 충족하는 마지막 업데이트 제출

2021년 7월 31일

마지막으로 확인됨

2021년 7월 1일

추가 정보

이 연구와 관련된 용어

약물 및 장치 정보, 연구 문서

미국 FDA 규제 의약품 연구

아니

미국 FDA 규제 기기 제품 연구

아니

이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .

관상동맥 질환에 대한 임상 시험

3
구독하다