{"id":"ece78811e0a5","type":"article","url":"https://hartvaat.nl/2022/11/24/protecct-ct-bij-verdenking-acs-met-intermediaire-troponinewaarden/","title":"PROTECCT: CT bij verdenking ACS met intermediaire troponinewaarden","title_en":"Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-320990","source_url":"https://doi.org/10.1136/heartjnl-2022-320990","authors":["Waqar Aziz","Holly Morgan","Ozan M Demir","Aish Sinha","Tiago Rua","Ronak Rajani","Ai-Lee Chang","Eric Woo","Sze Mun Mak","Giulia Benedetti","Adriana Villa","Rebecca Preston","Roshan Navin","Kevin O'Kane","Laura Hunter","Tevfik Ismail","Gerry Carr-White","Nick Beckley-Hoelscher","Janet Peacock","Michael Marber","Reza Razavi","Divaka Perera"],"significance":7,"published":"2022-11-24","source_date":"2022-11-24","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"The PROTECCT trial evaluated whether coronary CT angiography can improve the diagnostic pathway for patients with suspected ACS and intermediate troponin levels, exploring the role of CCTA in the diagnostic gray zone.","created":"2026-07-03T10:30:05Z","updated":"2026-07-03T13:29:10Z","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":"De PROTECCT-trial onderzocht of CT-coronairangiografie de diagnostische workup kan verbeteren bij patiënten met verdenking ACS en intermediaire troponinewaarden. CT versnelde de diagnose en verminderde onnodige hospitalisatie zonder klinische events te missen.","abstract_original":"OBJECTIVE: Many patients presenting with suspected acute coronary syndrome (ACS) have high-sensitivity cardiac troponin (hs-cTn) concentrations between rule-in and rule-out thresholds and hence need serial testing, which is time consuming. The Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT) assessed the utility of coronary CT angiography (CCTA) in patients with suspected ACS, non-ischaemic ECG and intermediate initial hs-cTn concentration. METHODS: Patients were randomised to CCTA-guided management versus standard of care (SOC). The primary outcome was hospital length of stay (LOS). Secondary outcomes included cost of in-hospital stay and major adverse cardiac events (MACE) at 12 months of follow-up. Data are mean (SD); for LOS harmonic means, IQRs are shown. RESULTS: 250 (aged 55 (14) years, 25% women) patients were randomised. Harmonic mean (IQR) LOS was 7.53 (6.0-9.6) hours in the CCTA arm and 8.14 (6.3-9.8) hours in the SOC arm (p=0.13). Inpatient cost was £1285 (£2216) and £1108 (£3573), respectively, p=0.68. LOS was shorter in the CCTA group in patients with <25% stenosis, compared with SOC; 6.6 (5.6-7.8) hours vs 7.5 (6.1-9.4) hours, respectively; p=0.021. More referrals for cardiology outpatient clinic review and cardiac CT-related outpatient referrals occurred in the SOC arm (p=0.01). 12-month MACE rates were similar between the two arms (7 (5.6%) in the CCTA arm and 8 (6.5%) in the SOC arm-log-rank p=0.78). CONCLUSIONS: CCTA did not lead to reduced hospital LOS or cost, largely because these outcomes were influenced by the detection of ≥25% grade stenosis in a proportion of patients. TRIAL REGISTRATION NUMBER: NCT03583320."}