CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial
SCOT-HEART investigators, David Newby, Michelle Williams, Amanda Hunter, Tania Pawade, Anoop Shah, David Newby, Andrew Flapan, John Forbes, Allister Hargreaves, Stephen Leslie, Steff Lewis, Graham McKillop, Scott McLean, John Reid, James Spratt, Neal Uren, Adam Timmis, Colin Berry, Nicholas Boon, Liz Clark, Peter Craig, Tom Barlow, Marcus Flather, John Forbes, Steff Lewis, Chiara McCormack, Scott McLean, David Newby, Giles Roditi, Edwin van Beek, Michelle Williams, Amanda Hunter, Susan Shepherd, Marise Bucukoglu, Steff Lewis, Valentina Assi, Richard Parker, Ashma Krishan, Chiara McCormack, Fiona Wee, Anthony Wackett, Allan Walker, Lynsey Milne, Kat Oatey, Paul Neary, Gillian Donaldson, Terry Fairbairn, Marlene Fotheringham, Fiona Hall, Allister Hargreaves, James Spratt, 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, 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, Edwin van Beek, Miles Behan, Danielle Bertram, David Brian, Amy Cowan, Nicholas Cruden, Martin Denvir, Marc Dweck, Laura Flint, Andrew Flapan, 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, John Reid, Neal Uren, 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, David Newby, Peter Bloomfield, Martin Denvir, Peter Henriksen, Donald MacLeod, Avril Morrison, Colin Berry, Kenneth Mangion, Ify Mordi, Giles Roditi, 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 Newby, Michelle Williams, Amanda Hunter, Tania Pawade, Anoop Shah, David Newby, Andrew Flapan, John Forbes, Allister Hargreaves, Stephen Leslie, Steff Lewis, Graham McKillop, Scott McLean, John Reid, James Spratt, Neal Uren, Adam Timmis, Colin Berry, Nicholas Boon, Liz Clark, Peter Craig, Tom Barlow, Marcus Flather, John Forbes, Steff Lewis, Chiara McCormack, Scott McLean, David Newby, Giles Roditi, Edwin van Beek, Michelle Williams, Amanda Hunter, Susan Shepherd, Marise Bucukoglu, Steff Lewis, Valentina Assi, Richard Parker, Ashma Krishan, Chiara McCormack, Fiona Wee, Anthony Wackett, Allan Walker, Lynsey Milne, Kat Oatey, Paul Neary, Gillian Donaldson, Terry Fairbairn, Marlene Fotheringham, Fiona Hall, Allister Hargreaves, James Spratt, 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, 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, Edwin van Beek, Miles Behan, Danielle Bertram, David Brian, Amy Cowan, Nicholas Cruden, Martin Denvir, Marc Dweck, Laura Flint, Andrew Flapan, 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, John Reid, Neal Uren, 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, David Newby, Peter Bloomfield, Martin Denvir, Peter Henriksen, Donald MacLeod, Avril Morrison, Colin Berry, Kenneth Mangion, Ify Mordi, Giles Roditi, 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: The benefit of CT coronary angiography (CTCA) in patients presenting with stable chest pain has not been systematically studied. We aimed to assess the effect of CTCA on the diagnosis, management, and outcome of patients referred to the cardiology clinic with suspected angina due to coronary heart disease.
Methods: In this prospective open-label, parallel-group, multicentre trial, we recruited patients aged 18-75 years referred for the assessment of suspected angina due to coronary heart disease from 12 cardiology chest pain clinics across Scotland. We randomly assigned (1:1) participants to standard care plus CTCA or standard care alone. Randomisation was done with a web-based service to ensure allocation concealment. The primary endpoint was certainty of the diagnosis of angina secondary to coronary heart disease at 6 weeks. All analyses were intention to treat, and patients were analysed in the group they were allocated to, irrespective of compliance with scanning. This study is registered with ClinicalTrials.gov, number NCT01149590.
Findings: Between Nov 18, 2010, and Sept 24, 2014, we randomly assigned 4146 (42%) of 9849 patients who had been referred for assessment of suspected angina due to coronary heart disease. 47% of participants had a baseline clinic diagnosis of coronary heart disease and 36% had angina due to coronary heart disease. At 6 weeks, CTCA reclassified the diagnosis of coronary heart disease in 558 (27%) patients and the diagnosis of angina due to coronary heart disease in 481 (23%) patients (standard care 22 [1%] and 23 [1%]; p<0·0001). Although both the certainty (relative risk [RR] 2·56, 95% CI 2·33-2·79; p<0·0001) and frequency of coronary heart disease increased (1·09, 1·02-1·17; p=0·0172), the certainty increased (1·79, 1·62-1·96; p<0·0001) and frequency seemed to decrease (0·93, 0·85-1·02; p=0·1289) for the diagnosis of angina due to coronary heart disease. This changed planned investigations (15% vs 1%; p<0·0001) and treatments (23% vs 5%; p<0·0001) but did not affect 6-week symptom severity or subsequent admittances to hospital for chest pain. After 1·7 years, CTCA was associated with a 38% reduction in fatal and non-fatal myocardial infarction (26 vs 42, HR 0·62, 95% CI 0·38-1·01; p=0·0527), but this was not significant.
Interpretation: In patients with suspected angina due to coronary heart disease, CTCA clarifies the diagnosis, enables targeting of interventions, and might reduce the future risk of myocardial infarction.
Funding: The Chief Scientist Office of the Scottish Government Health and Social Care Directorates funded the trial with supplementary awards from Edinburgh and Lothian's Health Foundation Trust and the Heart Diseases Research Fund.
Copyright © 2015 Newby et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.
Source: PubMed