Although coronary computed tomographic angiography (CTA) is known to improve diagnostic certainty in the assessment of patients with stable chest pain, little is known of its potential benefit to clinical outcomes.
In the SCOT-HEART trial, 4146 patients with stable chest pain were assigned 1:1 to standard care plus CTA or standard care alone. Investigations, treatments, and clinical outcomes were assessed over 3–7 years’ follow-up; median duration of follow-up was 4.8 years.
The 5-year rate of death from coronary heart disease or nonfatal myocardial infarction (the primary endpoint) was lower in the CTA group than in the standard-care group (2.3% vs 3.9%; p=0.004), and although overall rates of coronary angiography and coronary revascularization were similar at 5 years, more preventive and antianginal therapies (19.4% vs 14.7% and 13.2% vs 10.7%, respectively) were initiated in patients in the CTA vs standard care group during the study period.
So it appears that the information provided by a coronary CTA can resonate therapeutically beyond making a correct diagnosis of coronary artery disease, and could significantly reduce deaths from coronary heart disease or nonfatal myocardial infarction at 5 years in patients with stable heart pain, without resulting in a significantly higher rate of coronary angiography or revascularization.
Author: Daniel Guns