Coronary computed tomography angiography (CTA) may consistently improve coronary heart disease outcomes in individuals with chest pain, according to study results published in the Journal of the American College of Cardiology.
In patients with stable chest pain, the use of coronary CTA as a diagnostic test offers short-term benefits including better diagnostic certainty and improved targeting of therapies. The use of coronary CTA in this patient population was found to reduce the rate of death from coronary heart disease or nonfatal myocardial infarction (primary endpoint) in the large-scale Scottish COmputed Tomography of the HEART Trial (SCOT-HEART)
The objective of this study was to assess the consistency and mechanisms of the 5-year reduction of the primary end point.
In this study, researchers performed a post hoc analysis of the SCOT-HEART trial using Cox regression to analyze clinical outcomes. For the SCOT-HEART trial, adults aged ≤75 with stable chest pain were invited between 2010 and 2014 to participate in the trial in 12 cardiology centers in Scotland. A total of 4146 patients were randomly assigned to receive standard care or standard care with coronary CTA (n=2073 in each group). The primary end point was assessed by symptom (ie, different types of chest pain, diagnosis, coronary revascularizations, and preventative therapies including antiplatelet and statin therapies).
Reductions in coronary events were found to be consistent across symptom and risk factors. In patients not diagnosed with angina due to coronary heart disease, the use of standard care in combination with coronary CTA vs alone was associated with a lower incidence rate of death from coronary heart disease or nonfatal myocardial infarction (incidence rate: 0.23; 95% CI, 0.13-0.35 per 100 patient years vs 0.59; 95% CI, 0.42-0.80 per 100 patient years, respectively; P <.001).
Patients referred for invasive coronary angiography treated with standard care plus CTA vs standard care alone had greater burden of coronary artery disease (P =.056), particularly patients without inducible ischemia on exercise testing. In patients who had coronary CTA plus standard care vs standard care alone had higher rates of coronary revascularization after 1 year (hazard ratio: 1.21; 95% CI, 1.01-1.46; P =.042), but lower rates after 1 year (hazard ratio: 0.59; 95% CI, 0.38-0.90; P =.015). Rates of preventative therapy use were nearly 3-fold higher in patients with vs without coronary artery disease, despite identical 10-year cardiovascular risk scores. Study limitations include a possible overestimation of some of the benefits of coronary CTA.
”We have presented a multifaceted analysis that consistently and robustly demonstrates the plausibility of a reduction in long-term coronary events consequent on investigating patients with stable chest pain using coronary CTA,” concluded the study authors “If we are to improve the prevention of future myocardial infarction, coronary CTA would appear to be the most effective and indeed the only proven investigative approach in patients with stable chest pain.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Adamson PD, Williams MC, Dweck MR, et al. Guiding therapy by coronary CT angiography improves outcomes in patients with stable chest pain. J Am Coll Cardiol. 2019;74(16):2058-2070.