Coronary CT angiography and 5-year risk of myocardial infarction

The SCOT-HEART Investigators, et al. (2018) Coronary CT angiography and 5-year risk of myocardial infarction. New England Journal of Medicine, 379(10), pp. 924-933. (doi: 10.1056/NEJMoa1805971) (PMID:30145934)

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).

• Item Type: Articles
• Additional Information: Supported primarily by a grant (CZH/4/588) from the Chief Scientist Office of the Scottish Government, with supplementary support from grants (CH/09/002 and RE/13/3/30183) from the British Heart Foundation, and from Edinburgh and Lothians Health Foundation Trust and the Heart Diseases Research Fund. Edinburgh Imaging (University of Edinburgh), the Edinburgh Clinical Research Facility, the Glasgow Clinical Research Facility, and the Clinical Research Centre Tayside are supported by NHS Research Scotland. The Royal Bank of Scotland funded the provision of a 320-slice multidetector computed tomographic scanner for NHS Lothian and the University of Edinburgh.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Berry, Professor Colin and Johnstone, Mrs Janet and Mclennan, Miss Evonne and Lanaghan, Mrs Kirsten and Brown, Mrs Ammani and Frood, Mrs Alison and Newby, Professor David and Tzemos, Dr Nikolaos and Connolly, Dr Eugene and Roditi, Dr Giles and Glover, Miss Caroline and Mangion, Dr Kenneth and Woodward, Miss Rosemary and Mordi, Dr Ify and McGregor, Miss Lorraine and Boylan, Mrs Heather
• Authors: The SCOT-HEART Investigators, , Newby, D. E., Adamson, P. D., Berry, C., Boon, N. A., Dweck, M. R., Flather, M., Forbes, J., Hunter, A., Lewis, S., MacLean, S., Mills, N. L., Norrie, J., Roditi, G., Shah, A. S.V., Timmis, A. D., van Beek, E. J.R., Williams, M. C., Mangion, K., Mordi, I., Tzemos, N., Connolly, E., Boylan, H., Brown, A., Farrell, L., Frood, A., Glover, C., Johnstone, J., Lanaghan, K., McGlynn, D., McGregor, L., McLennan, E., Murdoch, L., Paterson, V., Teyhan, F., Teenan, M., Woodward, R., and Steedman, T.
• College/School: College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: New England Journal of Medicine
• Publisher: Massachusetts Medical Society
• ISSN: 0028-4793
• ISSN (Online): 1533-4406
• Published Online: 25 August 2018
• Copyright Holders: Copyright © 2018 Massachusetts Medical Society
• First Published: First published in New England Journal of Medicine 379(10): 924-933
• Publisher Policy: Reproduced in accordance with the publisher copyright policy