Use of Coronary Computed Tomographic Angiography to guide management of patients with coronary disease

Williams, Michelle C., Hunter, Amanda, Shah, Anoop S. V., Assi, Valentina, Lewis, Stephanie, Smith, Joel, Berry, Colin, Boon, Nicholas A., Clark, Elizabeth, Flather, Marcus, Forbes, John, Mclean, Scott, Roditi, Giles, Van Beek, Edwin J. R., Timmis, Adam D. and Newby, David E. (2016) Use of Coronary Computed Tomographic Angiography to guide management of patients with coronary disease. Journal of the American College of Cardiology, 67 (15). pp. 1759-1768. ISSN 0735-1097

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Background In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621). Conclusions In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)

Item Type: Article
Uncontrolled Keywords: angina pectoris,invasive coronary angiography,myocardial infarction,preventive therapy
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: Pure Connector
Date Deposited: 03 May 2016 13:00
Last Modified: 22 Oct 2022 01:06
DOI: 10.1016/j.jacc.2016.02.026

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