Objectives To establish if the use of early computed tomography (CT) coronary angiography improves one year clinical outcomes in patients presenting to the emergency department with acute chest pain and at intermediate risk of acute coronary syndrome and subsequent clinical events. Design Randomised controlled trial. Setting 37 hospitals in the UK. Participants Adults with suspected or a provisional diagnosis of acute coronary syndrome and one or more of previous coronary heart disease, raised levels of cardiac troponin, or abnormal electrocardiogram. Interventions Early CT coronary angiography and standard of care compared with standard of care only. Main outcome measures Primary endpoint was all cause death or subsequent type 1 or 4b myocardial infarction at one year. Results Between 23 March 2015 and 27 June 2019, 1748 participants (mean age 62 years (standard deviation 13), 64% men, mean global registry of acute coronary events (GRACE) score 115 (standard deviation 35)) were randomised to receive early CT coronary angiography (n=877) or standard of care only (n=871). Median time from randomisation to CT coronary angiography was 4.2 (interquartile range 1.6-21.6) hours. The primary endpoint occurred in 51 (5.8%) participants randomised to CT coronary angiography and 53 (6.1%) participants who received standard of care only (adjusted hazard ratio 0.91 (95% confidence interval 0.62 to 1.35), P=0.65). Invasive coronary angiography was performed in 474 (54.0%) participants randomised to CT coronary angiography and 530 (60.8%) participants who received standard of care only (adjusted hazard ratio 0.81 (0.72 to 0.92), P=0.001). There were no overall differences in coronary revascularisation, use of drug treatment for acute coronary syndrome, or subsequent preventive treatments between the two groups. Early CT coronary angiography was associated with a slightly longer time in hospital (median increase 0.21 (95% confidence interval 0.05 to 0.40) days from a median hospital stay of 2.0 to 2.2 days). Conclusions In intermediate risk patients with acute chest pain and suspected acute coronary syndrome, early CT coronary angiography did not alter overall coronary therapeutic interventions or one year clinical outcomes, but reduced rates of invasive angiography while modestly increasing length of hospital stay. These findings do not support the routine use of early CT coronary angiography in intermediate risk patients with acute chest pain and suspected acute coronary syndrome. Trial registration [ISRCTN19102565][1], [NCT02284191][2]. Deidentified individual participant data will be made available one year after publication of the primary manuscript. Data requests should be submitted to the corresponding author. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN19102565 [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02284191&atom=%2Fbmj%2F374%2Fbmj.n2106.atom

中文翻译：

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疑似急性冠状动脉综合征患者的早期计算机断层扫描冠状动脉造影：随机对照试验

目的 确定早期计算机断层扫描 (CT) 冠状动脉造影的使用是否能改善急诊科就诊的急性胸痛和急性冠状动脉综合征及后续临床事件中等风险患者的一年临床结果。设计随机对照试验。在英国设置了 37 家医院。参与者 怀疑或临时诊断为急性冠状动脉综合征和一种或多种既往冠心病、心肌肌钙蛋白水平升高或心电图异常的成人。干预措施 早期 CT 冠状动脉造影和护理标准与仅护理标准相比。主要结果测量 主要终点是一年内全因死亡或随后的 1 型或 4b 型心肌梗死。2015 年 3 月 23 日至 2019 年 6 月 27 日期间的结果，1748 名参与者（平均年龄 62 岁（标准差 13），64% 男性，平均全球急性冠脉事件登记 (GRACE) 评分 115（标准差 35））随机接受早期 CT 冠状动脉造影（n=877）或标准仅护理（n = 871）。从随机化到 CT 冠状动脉造影的中位时间为 4.2 小时（四分位距 1.6-21.6）小时。主要终点发生在随机接受 CT 冠状动脉造影的 51 名 (5.8%) 参与者和仅接受标准护理的 53 名 (6.1%) 参与者中（调整后的风险比 0.91（95% 置信区间 0.62 至 1.35），P=0.65）。474 名（54.0%）随机接受 CT 冠状动脉造影的参与者和 530 名（60.8%）仅接受标准治疗的参与者进行了侵入性冠状动脉造影（调整后的风险比 0.81（0.72 至 0.92），P=0.001）。两组在冠状动脉血运重建、急性冠状动脉综合征的药物治疗或后续预防性治疗方面没有总体差异。早期 CT 冠状动脉造影与住院时间稍长相关（中位住院时间为 2.0 至 2.2 天，中位数增加 0.21（95% 置信区间 0.05 至 0.40）天）。结论 在患有急性胸痛和疑似急性冠状动脉综合征的中危患者中，早期 CT 冠状动脉造影不会改变整体冠状动脉治疗干预或一年的临床结果，但会降低侵入性血管造影的发生率，同时适度增加住院时间。这些发现不支持在急性胸痛和疑似急性冠状动脉综合征的中危患者中常规使用早期 CT 冠状动脉造影。试用注册 [ISRCTN19102565][1]、[NCT02284191][2]。未识别的个人参与者数据将在主要手稿出版一年后提供。数据请求应提交给通讯作者。[1]：/external-ref?link_type=ISRCTN&access_num=ISRCTN19102565 [2]：/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02284191&atom=%2Fbmj%2F374%2Fbmj.n2106.atom