Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography for Interventional Triage in Acute Coronary Syndrome - Design of the Randomized TRACTION Trial

Mathias Holm Sørgaard; Andreas Torp Kristensen; Kristian Eskesen; Klaus Fuglsang Kofoed; Jesper James Linde; Henning Kelbæk; Michael Ottesen; Keld Neland; Charlotte Kragelund; Mette Lykke Norgaard Bertelsen; Jens Dahlgaard Hove; Gorm Mørk; Ole Peter Kristiansen; Thomas Engstrøm; Jacob Thomsen Lønborg; Jørgen Tobias Kühl; Signe Stelling Risom; Paul Blanche; Niels Thue Olsen

doi:10.1016/j.ahj.2025.107325

Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography for Interventional Triage in Acute Coronary Syndrome - Design of the Randomized TRACTION Trial

Mathias Holm Sørgaard^*, Andreas Torp Kristensen, Kristian Eskesen, Klaus Fuglsang Kofoed, Jesper James Linde, Henning Kelbæk, Michael Ottesen, Keld Neland, Charlotte Kragelund, Mette Lykke Norgaard Bertelsen, Jens Dahlgaard Hove, Gorm Mørk, Ole Peter Kristiansen, Thomas Engstrøm, Jacob Thomsen Lønborg, Jørgen Tobias Kühl, Signe Stelling Risom, Paul Blanche, Niels Thue Olsen

^*Corresponding author for this work

Abstract

PURPOSE: In patients admitted with acute coronary syndrome, invasive coronary angiography (ICA) is performed to determine which patients need revascularization. Coronary computed tomography angiography (CCTA) offers a widely available, non-invasive alternative that could reduce patient discomfort, procedural risks, and healthcare costs. The current trial aims to determine whether CCTA is non-inferior to ICA in determining the interventional strategy for patients admitted with non-ST elevation acute coronary syndrome (NSTE-ACS).

METHODS: TRACTION (Team-based Interventional Triage in Acute Coronary Syndrome Based on Non-Invasive Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography) is a multi-center, randomized, open-label, non-inferiority trial enrolling 2,300 patients. Patients hospitalized with non-ST elevation myocardial infarction or unstable angina with ischemic changes on ECG will be randomized 1:1 to CCTA versus ICA (standard of care). In the CCTA group, a coronary team reviews the CCTA and clinical information to determine the interventional strategy. The primary composite endpoint is major adverse cardiac events at one year, comprised of all-cause mortality, non-fatal myocardial infarction, hospitalization due to refractory angina, or hospitalization due to heart failure. Secondary outcomes include cardiovascular death, revascularization, symptom status, procedure-related adverse events, and resource utilization. The trial is designed to demonstrate non-inferiority if the 95% confidence interval excludes an absolute risk difference of the primary endpoint larger than 5%.

PERSPECTIVES: If CCTA is shown to be non-inferior to ICA in patients admitted with NSTE-ACS, CCTA could become the preferred management in a large group of patients. This could result in fewer patients exposed to invasive procedures and improved resource utilization.

Original language	English
Article number	107325
Journal	American Heart Journal
Volume	294
ISSN	0002-8703
DOIs	https://doi.org/10.1016/j.ahj.2025.107325
Publication status	Published - 2026

Keywords

Acute Coronary Syndrome/diagnostic imaging
Computed Tomography Angiography/methods
Coronary Angiography/methods
Female
Humans
Male
Multicenter Studies as Topic
Non-ST Elevated Myocardial Infarction
Randomized Controlled Trials as Topic
Triage/methods

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Sørgaard, M. H., Kristensen, A. T., Eskesen, K., Kofoed, K. F., Linde, J. J., Kelbæk, H., Ottesen, M., Neland, K., Kragelund, C., Bertelsen, M. L. N., Hove, J. D., Mørk, G., Kristiansen, O. P., Engstrøm, T., Lønborg, J. T., Kühl, J. T., Risom, S. S., Blanche, P., & Olsen, N. T. (2026). Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography for Interventional Triage in Acute Coronary Syndrome - Design of the Randomized TRACTION Trial. American Heart Journal, 294, Article 107325. https://doi.org/10.1016/j.ahj.2025.107325

Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography for Interventional Triage in Acute Coronary Syndrome - Design of the Randomized TRACTION Trial. / Sørgaard, Mathias Holm ; Kristensen, Andreas Torp ; Eskesen, Kristian et al.
In: American Heart Journal, Vol. 294, 107325, 2026.

Research output: Contribution to journal › Journal article › Research › peer-review

Sørgaard, MH , Kristensen, AT , Eskesen, K , Kofoed, KF, Linde, JJ, Kelbæk, H, Ottesen, M, Neland, K, Kragelund, C , Bertelsen, MLN , Hove, JD , Mørk, G , Kristiansen, OP , Engstrøm, T , Lønborg, JT , Kühl, JT , Risom, SS, Blanche, P & Olsen, NT 2026, 'Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography for Interventional Triage in Acute Coronary Syndrome - Design of the Randomized TRACTION Trial', American Heart Journal, vol. 294, 107325. https://doi.org/10.1016/j.ahj.2025.107325

@article{337bb776e5954c90bd48013387d70583,

title = "Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography for Interventional Triage in Acute Coronary Syndrome - Design of the Randomized TRACTION Trial",

abstract = "PURPOSE: In patients admitted with acute coronary syndrome, invasive coronary angiography (ICA) is performed to determine which patients need revascularization. Coronary computed tomography angiography (CCTA) offers a widely available, non-invasive alternative that could reduce patient discomfort, procedural risks, and healthcare costs. The current trial aims to determine whether CCTA is non-inferior to ICA in determining the interventional strategy for patients admitted with non-ST elevation acute coronary syndrome (NSTE-ACS).METHODS: TRACTION (Team-based Interventional Triage in Acute Coronary Syndrome Based on Non-Invasive Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography) is a multi-center, randomized, open-label, non-inferiority trial enrolling 2,300 patients. Patients hospitalized with non-ST elevation myocardial infarction or unstable angina with ischemic changes on ECG will be randomized 1:1 to CCTA versus ICA (standard of care). In the CCTA group, a coronary team reviews the CCTA and clinical information to determine the interventional strategy. The primary composite endpoint is major adverse cardiac events at one year, comprised of all-cause mortality, non-fatal myocardial infarction, hospitalization due to refractory angina, or hospitalization due to heart failure. Secondary outcomes include cardiovascular death, revascularization, symptom status, procedure-related adverse events, and resource utilization. The trial is designed to demonstrate non-inferiority if the 95\% confidence interval excludes an absolute risk difference of the primary endpoint larger than 5\%.PERSPECTIVES: If CCTA is shown to be non-inferior to ICA in patients admitted with NSTE-ACS, CCTA could become the preferred management in a large group of patients. This could result in fewer patients exposed to invasive procedures and improved resource utilization.",

keywords = "Acute Coronary Syndrome/diagnostic imaging, Computed Tomography Angiography/methods, Coronary Angiography/methods, Female, Humans, Male, Multicenter Studies as Topic, Non-ST Elevated Myocardial Infarction, Randomized Controlled Trials as Topic, Triage/methods",

author = "S{\o}rgaard, \{Mathias Holm\} and Kristensen, \{Andreas Torp\} and Kristian Eskesen and Kofoed, \{Klaus Fuglsang\} and Linde, \{Jesper James\} and Henning Kelb{\ae}k and Michael Ottesen and Keld Neland and Charlotte Kragelund and Bertelsen, \{Mette Lykke Norgaard\} and Hove, \{Jens Dahlgaard\} and Gorm M{\o}rk and Kristiansen, \{Ole Peter\} and Thomas Engstr{\o}m and L{\o}nborg, \{Jacob Thomsen\} and K{\"u}hl, \{J{\o}rgen Tobias\} and Risom, \{Signe Stelling\} and Paul Blanche and Olsen, \{Niels Thue\}",

note = "Copyright {\textcopyright} 2025. Published by Elsevier Inc.",

year = "2026",

doi = "10.1016/j.ahj.2025.107325",

language = "English",

volume = "294",

journal = "American Heart Journal",

issn = "0002-8703",

publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography for Interventional Triage in Acute Coronary Syndrome - Design of the Randomized TRACTION Trial

AU - Sørgaard, Mathias Holm

AU - Kristensen, Andreas Torp

AU - Eskesen, Kristian

AU - Kofoed, Klaus Fuglsang

AU - Linde, Jesper James

AU - Kelbæk, Henning

AU - Ottesen, Michael

AU - Neland, Keld

AU - Kragelund, Charlotte

AU - Bertelsen, Mette Lykke Norgaard

AU - Hove, Jens Dahlgaard

AU - Mørk, Gorm

AU - Kristiansen, Ole Peter

AU - Engstrøm, Thomas

AU - Lønborg, Jacob Thomsen

AU - Kühl, Jørgen Tobias

AU - Risom, Signe Stelling

AU - Blanche, Paul

AU - Olsen, Niels Thue

PY - 2026

Y1 - 2026

N2 - PURPOSE: In patients admitted with acute coronary syndrome, invasive coronary angiography (ICA) is performed to determine which patients need revascularization. Coronary computed tomography angiography (CCTA) offers a widely available, non-invasive alternative that could reduce patient discomfort, procedural risks, and healthcare costs. The current trial aims to determine whether CCTA is non-inferior to ICA in determining the interventional strategy for patients admitted with non-ST elevation acute coronary syndrome (NSTE-ACS).METHODS: TRACTION (Team-based Interventional Triage in Acute Coronary Syndrome Based on Non-Invasive Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography) is a multi-center, randomized, open-label, non-inferiority trial enrolling 2,300 patients. Patients hospitalized with non-ST elevation myocardial infarction or unstable angina with ischemic changes on ECG will be randomized 1:1 to CCTA versus ICA (standard of care). In the CCTA group, a coronary team reviews the CCTA and clinical information to determine the interventional strategy. The primary composite endpoint is major adverse cardiac events at one year, comprised of all-cause mortality, non-fatal myocardial infarction, hospitalization due to refractory angina, or hospitalization due to heart failure. Secondary outcomes include cardiovascular death, revascularization, symptom status, procedure-related adverse events, and resource utilization. The trial is designed to demonstrate non-inferiority if the 95% confidence interval excludes an absolute risk difference of the primary endpoint larger than 5%.PERSPECTIVES: If CCTA is shown to be non-inferior to ICA in patients admitted with NSTE-ACS, CCTA could become the preferred management in a large group of patients. This could result in fewer patients exposed to invasive procedures and improved resource utilization.

AB - PURPOSE: In patients admitted with acute coronary syndrome, invasive coronary angiography (ICA) is performed to determine which patients need revascularization. Coronary computed tomography angiography (CCTA) offers a widely available, non-invasive alternative that could reduce patient discomfort, procedural risks, and healthcare costs. The current trial aims to determine whether CCTA is non-inferior to ICA in determining the interventional strategy for patients admitted with non-ST elevation acute coronary syndrome (NSTE-ACS).METHODS: TRACTION (Team-based Interventional Triage in Acute Coronary Syndrome Based on Non-Invasive Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography) is a multi-center, randomized, open-label, non-inferiority trial enrolling 2,300 patients. Patients hospitalized with non-ST elevation myocardial infarction or unstable angina with ischemic changes on ECG will be randomized 1:1 to CCTA versus ICA (standard of care). In the CCTA group, a coronary team reviews the CCTA and clinical information to determine the interventional strategy. The primary composite endpoint is major adverse cardiac events at one year, comprised of all-cause mortality, non-fatal myocardial infarction, hospitalization due to refractory angina, or hospitalization due to heart failure. Secondary outcomes include cardiovascular death, revascularization, symptom status, procedure-related adverse events, and resource utilization. The trial is designed to demonstrate non-inferiority if the 95% confidence interval excludes an absolute risk difference of the primary endpoint larger than 5%.PERSPECTIVES: If CCTA is shown to be non-inferior to ICA in patients admitted with NSTE-ACS, CCTA could become the preferred management in a large group of patients. This could result in fewer patients exposed to invasive procedures and improved resource utilization.

KW - Acute Coronary Syndrome/diagnostic imaging

KW - Computed Tomography Angiography/methods

KW - Coronary Angiography/methods

KW - Female

KW - Humans

KW - Male

KW - Multicenter Studies as Topic

KW - Non-ST Elevated Myocardial Infarction

KW - Randomized Controlled Trials as Topic

KW - Triage/methods

UR - https://www.scopus.com/pages/publications/105026723668

U2 - 10.1016/j.ahj.2025.107325

DO - 10.1016/j.ahj.2025.107325

M3 - Journal article

C2 - 41360328

SN - 0002-8703

VL - 294

JO - American Heart Journal

JF - American Heart Journal

M1 - 107325

ER -

Coronary Computed Tomography Angiography Versus Invasive Coronary Angiography for Interventional Triage in Acute Coronary Syndrome - Design of the Randomized TRACTION Trial

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