CT Stress Myocardial Perfusion, Fractional Flow Reserve and Angiography in Patients With Stable Chest Pain Syndromes

NCT ID: NCT04709900

Last Updated: 2022-12-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

2000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-12-03

Study Completion Date

2031-12-31

Brief Summary

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The purpose of the DYNAMITE trial (Dynamic CT stress myocardial perfusion, CT fractional flow reserve (FFR-CT) and coronary CT angiography for optimized treatment strategy in patients with chest pain syndromes) is to determine the ability of combined anatomical and functional cardiac CT imaging to improve morbidity and mortality in patients with suspected or known ischemic heart disease.

Detailed Description

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Trial design

The DYNAMITE trial is an investigator-initiated, randomised controlled, open-labelled trial conducted in the Capital Region of Copenhagen, Denmark

The following hypothesis will be tested:

* First primary hypothesis: A treatment strategy guided by combined dynamic CT myocardial stress perfusion, FFR-CT and CT coronary angiography improves clinical outcome compared with a conventional management strategy in patients with chronic chest pain syndromes
* Second primary hypothesis: A treatment strategy guided by combined dynamic CT stress myocardial perfusion, FFR-CT and CT coronary angiography results in improved symptom relief compared with a conventional management strategy in patients with chronic chest pain syndromes

Conditions

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Coronary Artery Disease Chest Syndrome Acute Myocardial Infarction Heart Failure Stroke Cardiovascular Diseases

Keywords

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Cardiac CT Chest pain Coronary artery disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intervention group

CT angiography, FFR-CT and dynamic CT stress myocardial perfusion guided treatment strategy

Group Type ACTIVE_COMPARATOR

CT angiography, FFR-CT and stress CT myocardial perfusion

Intervention Type DIAGNOSTIC_TEST

The study intervention team consists of a specialist in Cardiac CT imaging, an invasive cardiologist, a thoracic surgeon and a cardiology nurse specialist. Treatment strategy defined by the study team based on CT findings involve referral for percutaneous coronary intervention, Coronary Artery Bypass surgery and/or initiation of optimal medical therapy, in addition to potential supplementary diagnostic procedures.

Standard care group

Evaluation and treatment strategy according to contemporary clinical practice

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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CT angiography, FFR-CT and stress CT myocardial perfusion

The study intervention team consists of a specialist in Cardiac CT imaging, an invasive cardiologist, a thoracic surgeon and a cardiology nurse specialist. Treatment strategy defined by the study team based on CT findings involve referral for percutaneous coronary intervention, Coronary Artery Bypass surgery and/or initiation of optimal medical therapy, in addition to potential supplementary diagnostic procedures.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Chest pain in patients with clinically suspected or confirmed ischemic heart disease
* Clinical indication for non-acute coronary evaluation
* Status of coronary revascularization

1. With previous coronary revascularization - all patients
2. Without previous coronary revascularization

1. Age≄65 years - all patients with chest pain
2. Age\>50 - \<65 years - typical angina pectoris and at least one cardiovascular risk factor and/or previous myocardial infarction

* Typical angina requiring all 3 criteria present: a) constrictive discomfort in the front of the chest or in the neck, jaw, shoulder or arm, b) precipitated by physical exertion c) relieved by rest or nitrates within 5 min.
* Cardiovascular risk factors: hypertension, diabetes, hypercholesterolemia, current smoking, family history of ischemic heart disease, previous stroke, peripheral artery disease

Exclusion Criteria

* Persistent chest pain and signs of ongoing acute myocardial ischemia requiring acute coronary intervention
* Hospitalization and discharge with the confirmed diagnosis acute coronary syndrome (STEMI or NSTEMI) within the last 6 months
* Severe valvular heart disease as primary diagnosis and/or in potential need of percutaneous or surgical valve treatment
* Known severe heart failure (LVEF less than 35%)
* Language, cultural or mental factors preventing the patient from understanding the informed consent form
* Known atrial fibrillation
* Known renal impairment (estimated Glomerular Filtration Rate below \<30 ml/min)
* Known x-ray contrast allergy
* Known intolerance to adenosine infusion
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rigshospitalet, Denmark

OTHER

Sponsor Role lead

Responsible Party

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Klaus Fuglsang Kofoed

Clinical associated Research Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Klaus F Kofoed, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark

Locations

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Department of Cardiology and Radiology, Rigshospitalet, The Heart Center, Capital Region of Copenhagen, University of Copenhagen

Copenhagen, , Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Klaus F Kofoed, MD

Role: CONTACT

Phone: 004535458569

Email: [email protected]

Facility Contacts

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Klaus F Kofoed, MD, DmSc

Role: primary

Other Identifiers

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NNF19OC0057592

Identifier Type: -

Identifier Source: org_study_id