Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain.
Adamson PD., Williams MC., Dweck MR., Mills NL., Boon NA., Daghem M., Bing R., Moss AJ., Mangion K., Flather M., Forbes J., Hunter A., Norrie J., Shah ASV., Timmis AD., van Beek EJR., Ahmadi AA., Leipsic J., Narula J., Newby DE., Roditi G., McAllister DA., Berry C., SCOT-HEART Investigators None.
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