Symptoms and quality of life in patients with suspected angina undergoing CT coronary angiography: a randomised controlled trial

Michelle C Williams, Amanda Hunter, Anoop Shah, Valentina Assi, Stephanie Lewis, Kenneth Mangion, Colin Berry, Nicholas A Boon, Elizabeth Clark, Marcus Flather, John Forbes, Scott McLean, Giles Roditi, Edwin Jr van Beek, Adam D Timmis, David E Newby, Scottish COmputed Tomography of the HEART (SCOT-HEART) Trial Investigators, Michelle Williams, Tania Pawade, Andrew Flapan, Allister Hargreaves, Stephen Leslie, Graham McKillop, John Reid, James Spratt, Neal Uren, Peter Craig, Tom Barlow, Chiara McCormack, Susan Shepherd, Marise Bucukoglu, Richard Parker, Ashma Krishan, Fiona Wee, Anthony Wackett, Allan Walker, Lynsey Milne, Kat Oatey, Paul Neary, Gillian Donaldson, Terry Fairbairn, Marlene Fotheringham, Fiona Hall, Stephen Glen, Sarah Perkins, Fiona Taylor, Louisa Cram, Catherine Beveridge, Avril Cairns, Frances Dougherty, Hany Eteiba, Alan Rae, Kate Robb, Wenda Crawford, Patricia Clarkin, Elisabeth Lennon, Graeme Houston, Stuart Pringle, Guntur Ramkumar Prasad, Thiru Sudarshan, Yvonne Fogarty, Dawn Barrie, Kim Bissett, Adelle Dawson, Scott Dundas, Deborah Letham, Linda O'Neill, Valerie Ritchie, Jonathan Weir-McCall, Hamish Dougall, Faheem Ahmed, Alistair Cormack, Iain Findlay, Stuart Hood, Clare Murphy, Eileen Peat, Lynne McCabe, Margaret McCubbin, Barbara Allen, Miles Behan, Danielle Bertram, David Brian, Amy Cowan, Nicholas Cruden, Martin Denvir, Marc Dweck, Laura Flint, Samantha Fyfe, Neil Grubb, Collette Keanie, Chris Lang, Tom MacGillivray, David MacLachlan, Margaret MacLeod, Saeed Mirsadraee, Avril Morrison, Nicholas Mills, David Northridge, Alyson Phillips, Laura Queripel, Nicholas Weir, Ashok Jacob, Fiona Bett, Frances Divers, Katie Fairley, Edith Keegan, Tricia White, Julia Fowler, John Gemmill, James McGowan, Margo Henry, Mark Francis, Dennis Sandeman, Lorraine Dinnel, Peter Bloomfield, Martin Denvir, Peter Henriksen, Donald MacLeod, Avril Morrison, Ify Mordi, Nikolaos Tzemos, Eugene Connolly, Heather Boylan, Ammani Brown, Lesley Farrell, Alison Frood, Caroline Glover, Janet Johnstone, Kirsten Lanaghan, Deborah McGlynn, Lorraine McGregor, Evonne McLennan, Laura Murdoch, Victoria Paterson, Fiona Teyhan, Marion Teenan, Rosie Woodward, Tracey Steedman, Michelle C Williams, Amanda Hunter, Anoop Shah, Valentina Assi, Stephanie Lewis, Kenneth Mangion, Colin Berry, Nicholas A Boon, Elizabeth Clark, Marcus Flather, John Forbes, Scott McLean, Giles Roditi, Edwin Jr van Beek, Adam D Timmis, David E Newby, Scottish COmputed Tomography of the HEART (SCOT-HEART) Trial Investigators, Michelle Williams, Tania Pawade, Andrew Flapan, Allister Hargreaves, Stephen Leslie, Graham McKillop, John Reid, James Spratt, Neal Uren, Peter Craig, Tom Barlow, Chiara McCormack, Susan Shepherd, Marise Bucukoglu, Richard Parker, Ashma Krishan, Fiona Wee, Anthony Wackett, Allan Walker, Lynsey Milne, Kat Oatey, Paul Neary, Gillian Donaldson, Terry Fairbairn, Marlene Fotheringham, Fiona Hall, Stephen Glen, Sarah Perkins, Fiona Taylor, Louisa Cram, Catherine Beveridge, Avril Cairns, Frances Dougherty, Hany Eteiba, Alan Rae, Kate Robb, Wenda Crawford, Patricia Clarkin, Elisabeth Lennon, Graeme Houston, Stuart Pringle, Guntur Ramkumar Prasad, Thiru Sudarshan, Yvonne Fogarty, Dawn Barrie, Kim Bissett, Adelle Dawson, Scott Dundas, Deborah Letham, Linda O'Neill, Valerie Ritchie, Jonathan Weir-McCall, Hamish Dougall, Faheem Ahmed, Alistair Cormack, Iain Findlay, Stuart Hood, Clare Murphy, Eileen Peat, Lynne McCabe, Margaret McCubbin, Barbara Allen, Miles Behan, Danielle Bertram, David Brian, Amy Cowan, Nicholas Cruden, Martin Denvir, Marc Dweck, Laura Flint, Samantha Fyfe, Neil Grubb, Collette Keanie, Chris Lang, Tom MacGillivray, David MacLachlan, Margaret MacLeod, Saeed Mirsadraee, Avril Morrison, Nicholas Mills, David Northridge, Alyson Phillips, Laura Queripel, Nicholas Weir, Ashok Jacob, Fiona Bett, Frances Divers, Katie Fairley, Edith Keegan, Tricia White, Julia Fowler, John Gemmill, James McGowan, Margo Henry, Mark Francis, Dennis Sandeman, Lorraine Dinnel, Peter Bloomfield, Martin Denvir, Peter Henriksen, Donald MacLeod, Avril Morrison, Ify Mordi, Nikolaos Tzemos, Eugene Connolly, Heather Boylan, Ammani Brown, Lesley Farrell, Alison Frood, Caroline Glover, Janet Johnstone, Kirsten Lanaghan, Deborah McGlynn, Lorraine McGregor, Evonne McLennan, Laura Murdoch, Victoria Paterson, Fiona Teyhan, Marion Teenan, Rosie Woodward, Tracey Steedman

Abstract

Background: In patients with suspected angina pectoris, CT coronary angiography (CTCA) clarifies the diagnosis, directs appropriate investigations and therapies, and reduces clinical events. The effect on patient symptoms is currently unknown.

Methods: In a prospective open-label parallel group multicentre randomised controlled trial, 4146 patients with suspected angina due to coronary heart disease were randomised 1:1 to receive standard care or standard care plus CTCA. Symptoms and quality of life were assessed over 6 months using the Seattle Angina Questionnaire and Short Form 12.

Results: Baseline scores indicated mild physical limitation (74±0.4), moderate angina stability (44±0.4), modest angina frequency (68±0.4), excellent treatment satisfaction (92±0.2) and moderate impairment of quality of life (55±0.3). Compared with standard care alone, CTCA was associated with less marked improvements in physical limitation (difference -1.74 (95% CIs, -3.34 to -0.14), p=0.0329), angina frequency (difference -1.55 (-2.85 to -0.25), p=0.0198) and quality of life (difference -3.48 (-4.95 to -2.01), p<0.0001) at 6 months. For patients undergoing CTCA, improvements in symptoms were greatest in those diagnosed with normal coronary arteries or who had their preventative therapy discontinued, and least in those with moderate non-obstructive disease or had a new prescription of preventative therapy (p<0.001 for all).

Conclusions: While improving diagnosis, treatment and outcome, CTCA is associated with a small attenuation of the improvements in symptoms and quality of life due to the detection of moderate non-obstructive coronary artery disease.

Trial registration number: NCT01149590.

Conflict of interest statement

Competing interests: DEN, EvB, GR and GMcK have received honoraria and consultancy from Toshiba Medical Systems. GR has received honoraria from companies (Bracco, Bayer-Schering, GE Healthcare and Guerbet) producing contrast media. DEN (CH/09/002) and MCW (FS/11/014) are supported by the British Heart Foundation. DEN is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). AT is supported by Barts Cardiovascular Biomedical Research Unit, funded by the National Institute for Health Research. EvB is supported by the Scottish Imaging Network: A Platform of Scientific Excellence (SINAPSE).

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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Source: PubMed

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