Coronary CT-angiography-guided management improves outcomes in patients with stable chest pain

1. Composite of coronary heart disease death and non-fatal myocardial infarction was less frequent in the CCTA group compared to standard care.

2. Major adverse cardiovascular events were also fewer in the CCTA group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The SCOT-HEART trial showed that coronary CT angiography-guided management improved outcomes for patients with stable chest pain. The trial demonstrated that CCTA could better diagnose coronary heart disease and guide treatment decisions. This randomized controlled trial aimed to evaluate whether CCTA-guided care leads to long-term, sustained improvements in management and outcomes in these patients. The primary outcome of this study was coronary heart disease death or non-fatal myocardial infarction, while a key secondary outcome was the rate of non-fatal myocardial infarctions. According to study results, patients in the CCTA group had fewer coronary heart disease deaths or non-fatal myocardial infarctions compared to the standard care group. Although this study was well done, it was limited by the lack of blinding and its observational nature for some long-term data.

Click to read the study in The Lancet

Relevant Reading: CT or Invasive Coronary Angiography in Stable Chest Pain

In-depth [randomized controlled trial]: Between Nov 18, 2010, and Sept 24, 2014, 9849 patients were assessed for eligibility across 12 cardiology clinics in Scotland. Included were patients aged ≥ 18 years with suspected stable angina due to coronary heart disease. Altogether, 4146 patients (2073 each to CCTA and standard care) were included in the final analysis. The primary outcome of coronary heart disease death or non-fatal myocardial infarction was less frequent in the CCTA group compared to the standard care group (6.6% vs. 8.2%, hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.63-0.99, p<0.05). The secondary outcome of non-fatal myocardial infarction and major cardiovascular events also showed fewer occurrences in the CCTA group (8.3% vs. 10.3%, HR 0.80, 95% CI 0.65-0.97, p<0.05). Findings from this study suggest that CCTA-guided management prevents coronary heart disease death.

Image: PD

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