Coronary CT Angiography and 5-Year Risk of Myocardial Infarction
SCOT-HEART Investigators, David E Newby, Philip D Adamson, Colin Berry, Nicholas A Boon, Marc R Dweck, Marcus Flather, John Forbes, Amanda Hunter, Stephanie Lewis, Scott MacLean, Nicholas L Mills, John Norrie, Giles Roditi, Anoop S V Shah, Adam D Timmis, Edwin J R van Beek, Michelle C Williams, Tania Pawade, Andrew Flapan, Allister Hargreaves, Stephen Leslie, Graham McKillop, Scott McLean, John Reid, James Spratt, Neal Uren, Liz Clark, Peter Craig, Tom Barlow, Chiara McCormack, Susan Shepherd, Marise Bucukoglu, Valentina Assi, 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, Louiza Cram, Catherine Beveridge, Avril Cairns, Frances Dougherty, Hany Eteiba, Alan Rae, Kate Robb, Wenda Crawford, Patricia Clarkin, Elizabeth Lennon, Graeme Houston, Stuart Pringle, Prasad Guntur Ramkumar, 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, Laura Flint, Samantha Fyfe, Neil Grubb, Collette Keanie, Chris Lang, Tom MacGillivray, David MacLachlan, Margaret MacLeod, Saeed Mirsadraee, Avril Morrison, 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, Peter Henriksen, Donald MacLeod, Kenneth Mangion, 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, SCOT-HEART Investigators, David E Newby, Philip D Adamson, Colin Berry, Nicholas A Boon, Marc R Dweck, Marcus Flather, John Forbes, Amanda Hunter, Stephanie Lewis, Scott MacLean, Nicholas L Mills, John Norrie, Giles Roditi, Anoop S V Shah, Adam D Timmis, Edwin J R van Beek, Michelle C Williams, Tania Pawade, Andrew Flapan, Allister Hargreaves, Stephen Leslie, Graham McKillop, Scott McLean, John Reid, James Spratt, Neal Uren, Liz Clark, Peter Craig, Tom Barlow, Chiara McCormack, Susan Shepherd, Marise Bucukoglu, Valentina Assi, 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, Louiza Cram, Catherine Beveridge, Avril Cairns, Frances Dougherty, Hany Eteiba, Alan Rae, Kate Robb, Wenda Crawford, Patricia Clarkin, Elizabeth Lennon, Graeme Houston, Stuart Pringle, Prasad Guntur Ramkumar, 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, Laura Flint, Samantha Fyfe, Neil Grubb, Collette Keanie, Chris Lang, Tom MacGillivray, David MacLachlan, Margaret MacLeod, Saeed Mirsadraee, Avril Morrison, 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, Peter Henriksen, Donald MacLeod, Kenneth Mangion, 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: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown.
Methods: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years.
Results: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause.
Conclusions: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .).
Source: PubMed