Use of coronary computed tomographic angiography to guide management of patients with coronary disease

Williams, M. C. et al. (2016) Use of coronary computed tomographic angiography to guide management of patients with coronary disease. Journal of the American College of Cardiology, 67(15), pp. 1759-1768. (doi:10.1016/j.jacc.2016.02.026) (PMID:27081014) (PMCID:PMC4829708)

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Abstract

Background: In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives: The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods: In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results: Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621). Conclusions: In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Roditi, Dr Giles
Authors: Williams, M. C., Hunter, A., Shah, A. S.V., Assi, V., Lewis, S., Smith, J., Berry, C., Boon, N. A., Clark, E., Flather, M., Forbes, J., McLean, S., Roditi, G., van Beek, E. J.R., Timmis, A. D., and Newby, D. E.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of the American College of Cardiology
Publisher:Elsevier Inc.
ISSN:0735-1097
ISSN (Online):1558-3597
Published Online:11 April 2016
Copyright Holders:Copyright © 2016 American College of Cardiology Foundation
First Published:First published in Journal of the American College of Cardiology 67(15):1759-1768
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher
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