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Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain

Philip D Adamson1, Michelle C Williams2, Marc R Dweck2

  • 1British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.

Journal of the American College of Cardiology
|October 19, 2019
PubMed

Insights

Coronary computed tomography angiography (CTA) in stable chest pain patients reduced coronary heart disease death or heart attack. This benefit was consistent across groups, driven by better targeting of preventative treatments.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Clinical Trials

Background:

  • The SCOT-HEART trial investigated coronary computed tomography angiography (CTA) in patients with stable chest pain.
  • CTA use was previously shown to reduce the primary endpoint of death from coronary heart disease or nonfatal myocardial infarction.

Purpose of the Study:

  • To assess the consistency of the 5-year reduction in the primary endpoint.
  • To explore the mechanisms underlying this observed outcome reduction.

Main Methods:

  • An open-label trial involving 4,146 participants randomized to standard care or standard care plus coronary CTA.
  • Exploration of the primary endpoint by symptoms, diagnosis, coronary revascularizations, and preventative therapies.

Main Results:

  • Event reductions were consistent across symptom and risk categories.
  • Coronary CTA was associated with a lower primary endpoint incidence in patients not diagnosed with angina.
  • Coronary revascularization rates were higher initially but lower long-term with CTA; preventative therapies increased, especially in those with CT-defined coronary artery disease.

Conclusions:

  • The beneficial effect of coronary CTA on outcomes is consistent across subgroups.
  • Coronary CTA improves outcomes by enabling better targeting of preventative treatments for coronary artery disease.
Abstract

Keywords:
angina pectoriscomputed tomographycoronary heart disease

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