Strategy for Unstable Coronary Plaque in Patients Presenting to Emergency Department for Chest Pain Suspected of Coronary Artery Disease

Launched by CENTRE HOSPITALIER INTERCOMMUNAL DE TOULON LA SEYNE SUR MER · Aug 22, 2023

Keywords

ClinConnect Summary

This clinical trial is studying a new approach to prevent heart disease in patients who come to the emergency department with chest pain that could be caused by blocked arteries. The goal is to identify patients at risk of serious heart problems, such as heart attacks, even if they don’t have clear symptoms. To do this, the doctors will use a test called calcium scoring, which helps categorize patients based on their risk of developing dangerous plaque in their arteries. Those with intermediate or high risk may undergo further testing using a special scan to look for unstable plaques, and if needed, they will be offered treatment to lower their risk.

To participate in this trial, you need to be between 18 and 80 years old and have no prior history of heart problems. You must also be evaluated and confirmed not to have an acute heart condition. Some people, like those who are pregnant, have certain medical conditions, or refuse follow-up care, may not be eligible. If you join, you can expect to undergo tests to assess your heart health and receive guidance on how to manage your risk of heart disease. This trial is currently recruiting participants and aims to improve prevention strategies for heart disease.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• * Patient with no coronary history presenting to the emergency room, to the assessment unit or having consulted in the cardiology department for suspicious chest pain that does not allow an acute coronary syndrome or angina to be excluded and:
• • in whom the diagnosis of acute coronary syndrome has been ruled out on the basis of clinical, electrocardiographic, biological monitoring, or even by imaging (including coronary angiography), in accordance with recommendations and good practices
• • in whom effort myocardial ischemia is rendered unlikely on the basis of a clinical and paraclinical evaluation (either ergometric or by functional imaging: scintigraphy, echography or stress MRI)
• • wishing diagnostic care and primary prevention of coronary disease.
• • Age above or equal to 18 and strictly below 80 years old
• • Having given informed consent
• Exclusion Criteria:
• • Pregnant woman
• • Patient with cognitive disorders
• • Claustrophobic patient, or refusing radiological examinations
• • Patient refusing cardiological follow-up and/or treatment of his risk factors or refusing to participate in the study
• • Patient with contraindications or intolerances to HMG-CoA reductase inhibitors (statins) and/or Ezetimibe
• • Patient with liver failure
• • Patient with myopathy or with a history of (rhabdo)myolysis
• • Marked arrhythmia and in particular supraventricular or ventricular hyperexcitability, or chronic or paroxysmal atrial fibrillation not controlled by antiarrhythmic treatment
• • Patients with a history of sternotomy or valve replacement or metallic intracardiac probes, generators of scanner artefacts
• • Calcium score corresponding to the percentiles of groups I and II
• * For patients in groups III and IV:
• • renal insufficiency with glomerular filtration rate estimated by the MDRD and/or CKD-EPI formula less than or equal to 55 ml/min/1.73 m2,
• • known intolerance to radiological contrast products, or in whom an injected CT scan has already been performed in the 6 months preceding inclusion
• • Person participating in another biomedical research
• • Person under judicial protection (guardianship, curatorship...)
• • Person deprived of liberty by a judicial or administrative decision.