Gray AJ, Roobottom C, Smith JE, et al. - Routine employment of early computed tomography (CT) coronary angiography in intermediate risk patients with acute chest pain and suspected acute coronary syndrome is not supported by the results of this randomised controlled trial.

• This study included adults with suspected or a provisional diagnosis of acute coronary syndrome and one or more of previous coronary heart disease, elevated concentrations of cardiac troponin, or abnormal electrocardiogram.

• Total 1748 participants were randomly assigned to receive early CT coronary angiography (n=877) or standard of care only (n=871).

• Occurrence of primary endpoint (all cause death or subsequent type 1 or 4b myocardial infarction at one year) was evident in 51 (5.8%) participants who had CT coronary angiography and 53 (6.1%) who underwent standard of care only (adjusted hazard ratio 0.91).

• Early CT coronary angiography failed to modify overall coronary therapeutic interventions or one year clinical results in intermediate risk patients with acute chest pain and suspected acute coronary syndrome.

• However, in these patients, early CT coronary angiography decreased rates of invasive angiography while modestly increasing length of hospital stay.