Adamson, P. D. et al. (2019) Guiding therapy by coronary CT angiography improves outcomes in patients with stable chest pain. Journal of the American College of Cardiology, 74(16), pp. 2058-2070. (doi: 10.1016/j.jacc.2019.07.085)
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Abstract
Background: Within the SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) trial of patients with stable chest pain, the use of coronary computed tomography angiography (CTA) reduced the rate of death from coronary heart disease or nonfatal myocardial infarction (primary endpoint). Objectives: This study sought to assess the consistency and mechanisms of the 5-year reduction in this endpoint. Methods: In this open-label trial, 4,146 participants were randomized to standard care alone or standard care plus coronary CTA. This study explored the primary endpoint by symptoms, diagnosis, coronary revascularizations, and preventative therapies. Results: Event reductions were consistent across symptom and risk categories (p = NS for interactions). In patients who were not diagnosed with angina due to coronary heart disease, coronary CTA was associated with a lower primary endpoint incidence rate (0.23; 95% confidence interval [CI]: 0.13 to 0.35 vs. 0.59; 95% CI: 0.42 to 0.80 per 100 patient-years; p < 0.001). In those who had undergone coronary CTA, rates of coronary revascularization were higher in the first year (hazard ratio [HR]: 1.21; 95% CI: 1.01 to 1.46; p = 0.042) but lower beyond 1 year (HR: 0.59; 95% CI: 0.38 to 0.90; p = 0.015). Patients assigned to coronary CTA had higher rates of preventative therapies throughout follow-up (p < 0.001 for all), with rates highest in those with CT-defined coronary artery disease. Modeling studies demonstrated the plausibility of the observed effect size. Conclusions: The beneficial effect of coronary CTA on outcomes is consistent across subgroups with plausible underlying mechanisms. Coronary CTA improves coronary heart disease outcomes by enabling better targeting of preventative treatments to those with coronary artery disease. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McAllister, Professor David and Mangion, Dr Kenneth and Roditi, Dr Giles and Berry, Professor Colin |
| Authors: | Adamson, P. D., Williams, M. C., Dweck, M. R., Mills, N. L., Boon, N. A., Daghem, M., Bing, R., Moss, A. J., Mangion, K., Flather, M., Forbes, J., Hunter, A., Norrie, J., Shah, A. S.V., Timmis, A. D., van Beek, E. J.R., Ahmadi, A. A., Leipsic, J., Narula, J., Newby, D. E., Roditi, G., McAllister, D. A., and Berry, C. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | Journal of the American College of Cardiology |
| Publisher: | Elsevier |
| ISSN: | 0735-1097 |
| ISSN (Online): | 1558-3597 |
| Published Online: | 14 October 2019 |
| Copyright Holders: | Copyright © 2019 The Authors |
| First Published: | First published in Journal of the American College of Cardiology 74(16):2058-2070 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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