OPENing a new ECLECTIC approach to NSTEMI and cardiac arrest using ECG-less coronary computed tomography angiography. Study design and rationale of two prospective clinical studies.

BACKGROUND

ECG-less coronary computed tomography angiography (CCTA) is a novel and promising tool for the diagnosis of coronary artery disease (CAD). Compared to conventional ECG-gated CCTA, it is less dependent on heart rate control and gives the possibility of ruling out both pulmonary embolism and CAD using a single contrast injection. Recently, it has shown good sensitivity in detecting obstructive CAD. Given the limitations of current emergency room algorithms-primarily based on clinical presentation, ECG, and biomarkers-the triage of patients with acute chest pain or cardiac arrest may benefit from this emerging imaging modality.

METHODS

We designed two prospective, single-center, double-blinded clinical studies to investigate the role of ECG-less CCTA in acute scenarios. The ECLECTIC study (ECG-LEss coronary Computed Tomography angiography in the management of patients presenting with hIgh-troponin and Chest pain, NCT07192965) will evaluate diagnostic accuracy and prognostic value in patients presenting with acute chest pain, mildly elevated troponin levels, and a high clinical suspicion of CAD. The OPEN-CCT Arrest (Optimizing Post-arrest Evaluation with Non-gated Cardiac CT) will assess the feasibility and diagnostic utility of this technique in cardiac arrest survivors. In both studies, patients will undergo ECG-less CCTA followed by ICA, considered the gold standard.

CLINICAL IMPLICATIONS: ECG-less CCTA pushes the boundaries of using CCTA in acute clinical scenarios. This technique may reduce preparation time and improve workflow, especially in highly instrumented patients. If its diagnostic accuracy and prognostic value are proven, ECG-less CCTA could significantly decrease the need for unnecessary invasive procedures, the length of hospital stay, and the overall healthcare costs.