ACR trial to question necessity of SPECT in CAD treatment planning

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The American College of Radiology (ACR) is launching a trial to determine whether patients with stable angina can safely undergo cardiac CT angiography (CCTA) to determine if plaque stenosis is the cause of their pain, instead of a SPECT myocardial perfusion imaging exam, that often is followed by invasive catheter angiography to assess the degree of coronary artery disease.

According to ACR, the Randomized Evaluation of Patients with Stable Angina Comparing Utilization of Noninvasive Examinations (RESCUE) trial will seek to enroll 4,300 participants across 80 institutions internationally in an attempt to understand whether any of the 500,000 patients diagnosed annually with stable angina experience any increase in myocardial infarctions, cardiac-related deaths or revascularization by undergoing CCTA alone.

Moreover, RESCUE will assess the potentially diminished risks (less radiation exposure) and reduced costs associated with using CCTA, as well as how CT can provide additional insights into alternate explanations of chest pain.

“With traditional SPECT-MPI, patients with a positive test for CAD will require invasive coronary angiography (ICA) to determine if they can safely be treated with pharmacologic therapy and lifestyle intervention, also known as optimal medical therapy, or OMT; however, recent research suggests that CCTA alone has the potential to determine which patients can be treated with OMT,” said principal investigator Arthur Stillman, MD, PhD, of Emory University in Atlanta.

The RESCUE trial will be conducted through the ACR Imaging Network (ACRIN) Cardiovascular Committee and will be funded by the Agency for Healthcare Quality and Research.