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ROMICAT II trial - Summary & Results

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ROMICAT II (Rule Out Myocardial Infarction Using Computer Assisted Tomography II) was designed following the completion of the observational ROMICAT study, which showed that about 8% of patients screened for ACS in emergency departments are actually suffering ACS

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ROMICAT II trial - Summary & Results

  1. 1. ROMICAT II (Rule Out MyocardialInfarction Using Computer AssistedTomography II)
  2. 2. ROMICAT II (Rule Out Myocardial Infarction UsingComputer Assisted Tomography II)U Hoffman (Massachusetts General Hospital, Boston)American College of Cardiology 2012 Scientific Sessions• ROMICAT II was designed following the completion of the observational ROMICAT study, which showed that about 8% of patients screened for ACS in emergency departments are actually suffering ACS• Population and treatment: 1000 chest-pain patients with suspected ACS Randomized on a 1:1 ratio to either a CCTA screening approach or standard care left to the discretion of the physician• Primary end point: To determine whether length of hospital stay is significantly reduced in the CCTA arm compared with the comparator arm ACS=acute coronary syndrome CCTA=coronary computed-tomography angiography
  3. 3. ROMICAT II: Results• Average time to diagnosis was 10.4 hours in the CCTA group and 18.7 hours in the control group (p=0.001)• By reducing time to diagnosis in patients not suffering an ACS, CCTA reduced chest-pain patients average hospital stay from ~31 hours to 23 hours (p=0.0002) vs the standard approach• CCTA patients were much more likely to be discharged directly from the emergency department (46.7% vs 12.4%) and slightly less likely to be admitted to the hospital (25.4% vs 31.7%)• No missed ACS cases in either group, and major adverse events within 30 days were similar in both CCTA and standard-care groups (0.4 and 1.0, p=0.37)• CCTA costs were similar to standard approach: CCTA cost about 19% less per patient, but hospital costs were about 50% more with the CCTA approach**CCTA patients underwent more angiography (12% vs 8%, p=0.04) and a statistically insignificantgreater number of coronary interventions—either percutaneous intervention or bypass surgery
  4. 4. ROMICAT II: Commentary*"Will a patient really see it as different having a CCTA and being discharged vsgoing down the hall [to the chest-pain unit] for a few hours? Is that a big difference?I dont think so. . . . As for time in the emergency department? Id view that assecondary." - Dr Ray Gibbons"Previous reports [from Medicare data] showed a doubling of the cost with CT, reallyattributed to subsequent catheterizations, bypass surgeries, and stent placements,so we were very happy to see no increase in costs. Thats a major step forward.“ - Dr Udo Hoffman*All comments from ROMICAT II: CT-first ACS strategy matches current practice(http://www.theheart.org/article/1376891.do)
  5. 5. Become a member of http://www.theheart.org Become a fan on Facebook: http://www.facebook.com/theheartorg Follow us on Twitter: http://www.twitter.com/theheartorgtheheart.org is the leading online source of independent cardiology news.We are the top provider of news and opinions for over 100 000 physicians.

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