{"id":"b6ebd9ac8a7d","type":"article","url":"https://hartvaat.nl/2016/01/05/ct-coronairangiografie-bij-verdenking-acs-in-het-tijdperk-van-hoog-sensitief-tro/","title":"CT-coronairangiografie bij verdenking ACS in het tijdperk van hoog-sensitief troponine","title_en":"Coronary CT Angiography for Suspected ACS in the Era of High-Sensitivity Troponins: Randomized Multicenter Study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","coronaire-ct-angiografie","hartkatheterisatie","iaso-dcm","troponine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2015.10.045","source_url":"https://doi.org/10.1016/j.jacc.2015.10.045","authors":["Admir Dedic","Marisa M Lubbers","Jeroen Schaap","Jeronymus Lammers","Evert J Lamfers","Benno J Rensing","Richard L Braam","Hendrik M Nathoe","Johannes C Post","Tim Nielen","Driek Beelen","Marie-Claire le Cocq d'Armandville","Pleunie P M Rood","Carl J Schultz","Adriaan Moelker","Mohamed Ouhlous","Eric Boersma","Koen Nieman"],"significance":7,"published":"2016-01-05","source_date":"2016-01-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/"],"congress":"","summary_en":"This randomized multicenter study evaluated whether early coronary CT angiography improves outcomes compared with contemporary standard care in patients with suspected acute coronary syndrome in the era of high-sensitivity troponin assays.","created":"2026-07-03T10:25:52Z","updated":"2026-07-03T13:25:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde multicenter studie die onderzoekt of een diagnostische strategie met vroege CT-coronairangiografie superieur is aan standaard optimale zorg met hoog-sensitieve troponine-assays bij verdenking op acuut coronair syndroom.","abstract_original":"BACKGROUND: It is uncertain whether a diagnostic strategy supplemented by early coronary computed tomography angiography (CCTA) is superior to contemporary standard optimal care (SOC) encompassing high-sensitivity troponin assays (hs-troponins) for patients suspected of acute coronary syndrome (ACS) in the emergency department (ED). OBJECTIVES: This study assessed whether a diagnostic strategy supplemented by early CCTA improves clinical effectiveness compared with contemporary SOC. METHODS: In a prospective, open-label, multicenter, randomized trial, we enrolled patients presenting with symptoms suggestive of an ACS at the ED of 5 community and 2 university hospitals in the Netherlands. Exclusion criteria included the need for urgent cardiac catheterization and history of ACS or coronary revascularization. The primary endpoint was the number of patients identified with significant coronary artery disease requiring revascularization within 30 days. RESULTS: The study population consisted of 500 patients, of whom 236 (47%) were women (mean age 54 ± 10 years). There was no difference in the primary endpoint (22 [9%] patients underwent coronary revascularization within 30 days in the CCTA group and 17 [7%] in the SOC group [p = 0.40]). Discharge from the ED was not more frequent after CCTA (65% vs. 59%, p = 0.16), and length of stay was similar (6.3 h in both groups; p = 0.80). The CCTA group had lower direct medical costs (€337 vs. €511, p < 0.01) and less outpatient testing after the index ED visit (10 [4%] vs. 26 [10%], p < 0.01). There was no difference in incidence of undetected ACS. CONCLUSIONS: CCTA, applied early in the work-up of suspected ACS, is safe and associated with less outpatient testing and lower costs. However, in the era of hs-troponins, CCTA does not identify more patients with significant CAD requiring coronary revascularization, shorten hospital stay, or allow for more direct discharge from the ED. (Better Evaluation of Acute Chest Pain with Computed Tomography Angiography [BEACON]; NCT01413282)."}