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Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.

, David E Newby1, Philip D Adamson1

  • 1From the University of Edinburgh, Edinburgh (D.E.N., P.D.A., N.A.B., M.R.D., A.H., S.L., N.L.M., J.N., A.S.V.S., E.J.R.B., M.C.W.), the University of Glasgow, Glasgow (C.B., G.R.), the University of East Anglia, Norwich (M.F.), NHS Fife, Kirkcaldy (S.M.), and Queen Mary University, London (A.D.T.) - all in the United Kingdom; and the University of Limerick, Limerick, Ireland (J.F.).

The New England Journal of Medicine
|August 28, 2018
PubMed
Summary

Coronary computed tomographic angiography (CTA) significantly reduced 5-year risks of coronary heart disease death or heart attack in stable chest pain patients. This approach improved outcomes without increasing invasive procedures, enhancing patient care.

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Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Clinical Trials

Background:

  • Coronary computed tomographic angiography (CTA) enhances diagnostic certainty for stable chest pain.
  • The long-term impact of CTA on 5-year clinical outcomes remained unknown prior to this study.

Purpose of the Study:

  • To evaluate the effect of adding CTA to standard care on 5-year clinical outcomes in patients with stable chest pain.

Main Methods:

  • An open-label, multicenter trial randomized 4146 patients with stable chest pain.
  • Patients received either standard care plus CTA or standard care alone.
  • The primary endpoint was death from coronary heart disease or nonfatal myocardial infarction at 5 years.

Main Results:

  • The 5-year rate of the primary endpoint was significantly lower in the CTA group (2.3%) compared to the standard care group (3.9%).
  • While initial rates of invasive coronary angiography and revascularization were higher in the CTA group, overall 5-year rates were similar between groups.
  • Patients receiving CTA were more likely to be initiated on preventive and antianginal therapies.

Conclusions:

  • Adding CTA to standard care significantly reduced the risk of coronary heart disease death or myocardial infarction at 5 years in stable chest pain patients.
  • The benefits were achieved without a significant increase in invasive coronary angiography or coronary revascularization rates.
  • CTA use led to increased initiation of preventive and antianginal therapies.