Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2

Everett, C. C. et al. (2023) Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2. Open Heart, 10(1), e002221. (doi: 10.1136/openhrt-2022-002221) (PMID:37130657) (PMCID:PMC10163591)

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Aims: Guidelines for suspected cardiac chest pain have used historical risk stratification tools, advocating invasive coronary angiography (ICA) first-line in those at highest risk. We aimed to determine whether different strategies to manage suspected stable angina affected medium-term cardiovascular event rates and patient-reported quality of life (QoL) measures. Methods: CE-MARC 2, a three-arm parallel group trial, randomised patients with suspected stable cardiac chest pain and a Duke Clinical pretest likelihood of coronary artery disease between 10% and 90%. Patients were randomised to either first-line cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT) or the UK National Institute for Health and Care Excellence (NICE) CG95 (2010) guidelines-directed care. For the three arms, 1-year and 3-year first major adverse cardiovascular event (MACE) rates and QoL assessed by the Seattle Angina Questionnaire, Short Form 12 (V.12) Questionnaire and EuroQol-5 Dimension Questionnaire were recorded. Results: 1202 patients were randomised to CMR (n=481), SPECT (n=481) and NICE (n=240). Forty-two patients (18 CMR, 18 SPECT, 6 NICE) experienced one or more MACEs. The percentage rates (95% CIs) of MACE in the CMR, SPECT and NICE groups at 3 years were 3.7% (2.4%, 5.8%), 3.7% (2.4%, 5.8%) and 2.1% (0.9%, 4.8%), respectively. QoL scores did not significantly differ across domains. Conclusion: Despite a fourfold increase in referrals for ICA, the NICE CG95 (2010) guidelines risk-stratified care strategy did not significantly reduce 3-year MACE or improve QoL, as compared with functional imaging with CMR or SPECT. Trial registration number: ClinicalTrials.gov Registry (NCT01664858).

Item Type:Articles
Additional Information:Funded by the British Heart Foundation (grant ref: SP/12/1/29062). CB, KM and ED'A are supported by research funding from the British Heart Foundation (RE/18/6134217; FS/15/54/31639; FS/13/71/30378, respectively).
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Mangion, Dr Kenneth
Authors: Everett, C. C., Berry, C., McCann, G. P., Fernandez, C., Reynolds, C., Bucciarelli-Ducci, C., Dall’Armellina, E., Prasad, A., Foley, J. R., Mangion, K., Bijsterveld, P., Brown, J., Stocken, D., Walker, S., Sculpher, M., Plein, S., and Greenwood, J. P.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Open Heart
Publisher:BMJ Publishing Group
ISSN (Online):2053-3624
Published Online:02 May 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in Open Heart 10(1): e002221
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
167165Clinical Evaluation of 3T Magnetic Resonance Imaging for the management of patients with Coronary heart disease: the CE-MARC2 studyColin BerryBritish Heart Foundation (BHF)SP/12/1/29062Institute of Cardiovascular & Medical Sciences
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
172173Myocardial strain measurements in survivors of acute ST-elevation myocardial infarction: implementation and prognostic significance of novel magnetic resonance imaging methods.Colin BerryBritish Heart Foundation (BHF)FS/15/54/31639Institute of Cardiovascular & Medical Sciences