Cargando…
Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain
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). OBJECTIV...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Biomedical
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899446/ https://www.ncbi.nlm.nih.gov/pubmed/31623764 http://dx.doi.org/10.1016/j.jacc.2019.07.085 |
_version_ | 1783477131971395584 |
---|---|
author | Adamson, Philip D. Williams, Michelle C. Dweck, Marc R. Mills, Nicholas L. Boon, Nicholas A. Daghem, Marwa Bing, Rong Moss, Alastair J. Mangion, Kenneth Flather, Marcus Forbes, John Hunter, Amanda Norrie, John Shah, Anoop S.V. Timmis, Adam D. van Beek, Edwin J.R. Ahmadi, Amir A. Leipsic, Jonathon Narula, Jagat Newby, David E. Roditi, Giles McAllister, David A. Berry, Colin |
author_facet | Adamson, Philip D. Williams, Michelle C. Dweck, Marc R. Mills, Nicholas L. Boon, Nicholas A. Daghem, Marwa Bing, Rong Moss, Alastair J. Mangion, Kenneth Flather, Marcus Forbes, John Hunter, Amanda Norrie, John Shah, Anoop S.V. Timmis, Adam D. van Beek, Edwin J.R. Ahmadi, Amir A. Leipsic, Jonathon Narula, Jagat Newby, David E. Roditi, Giles McAllister, David A. Berry, Colin |
author_sort | Adamson, Philip D. |
collection | PubMed |
description | 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 < 0.001). In those who had undergone coronary CTA, rates of coronary revascularization were higher in the first year (hazard ratio [HR]: 1.21; 95% CI: 1.01 to 1.46; p = 0.042) but lower beyond 1 year (HR: 0.59; 95% CI: 0.38 to 0.90; p = 0.015). Patients assigned to coronary CTA had higher rates of preventative therapies throughout follow-up (p < 0.001 for all), with rates highest in those with CT-defined coronary artery disease. Modeling studies demonstrated the plausibility of the observed effect size. CONCLUSIONS: The beneficial effect of coronary CTA on outcomes is consistent across subgroups with plausible underlying mechanisms. Coronary CTA improves coronary heart disease outcomes by enabling better targeting of preventative treatments to those with coronary artery disease. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590) |
format | Online Article Text |
id | pubmed-6899446 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier Biomedical |
record_format | MEDLINE/PubMed |
spelling | pubmed-68994462020-01-21 Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain Adamson, Philip D. Williams, Michelle C. Dweck, Marc R. Mills, Nicholas L. Boon, Nicholas A. Daghem, Marwa Bing, Rong Moss, Alastair J. Mangion, Kenneth Flather, Marcus Forbes, John Hunter, Amanda Norrie, John Shah, Anoop S.V. Timmis, Adam D. van Beek, Edwin J.R. Ahmadi, Amir A. Leipsic, Jonathon Narula, Jagat Newby, David E. Roditi, Giles McAllister, David A. Berry, Colin J Am Coll Cardiol Article 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 < 0.001). In those who had undergone coronary CTA, rates of coronary revascularization were higher in the first year (hazard ratio [HR]: 1.21; 95% CI: 1.01 to 1.46; p = 0.042) but lower beyond 1 year (HR: 0.59; 95% CI: 0.38 to 0.90; p = 0.015). Patients assigned to coronary CTA had higher rates of preventative therapies throughout follow-up (p < 0.001 for all), with rates highest in those with CT-defined coronary artery disease. Modeling studies demonstrated the plausibility of the observed effect size. CONCLUSIONS: The beneficial effect of coronary CTA on outcomes is consistent across subgroups with plausible underlying mechanisms. Coronary CTA improves coronary heart disease outcomes by enabling better targeting of preventative treatments to those with coronary artery disease. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590) Elsevier Biomedical 2019-10-22 /pmc/articles/PMC6899446/ /pubmed/31623764 http://dx.doi.org/10.1016/j.jacc.2019.07.085 Text en © 2019 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Adamson, Philip D. Williams, Michelle C. Dweck, Marc R. Mills, Nicholas L. Boon, Nicholas A. Daghem, Marwa Bing, Rong Moss, Alastair J. Mangion, Kenneth Flather, Marcus Forbes, John Hunter, Amanda Norrie, John Shah, Anoop S.V. Timmis, Adam D. van Beek, Edwin J.R. Ahmadi, Amir A. Leipsic, Jonathon Narula, Jagat Newby, David E. Roditi, Giles McAllister, David A. Berry, Colin Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain |
title | Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain |
title_full | Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain |
title_fullStr | Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain |
title_full_unstemmed | Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain |
title_short | Guiding Therapy by Coronary CT Angiography Improves Outcomes in Patients With Stable Chest Pain |
title_sort | guiding therapy by coronary ct angiography improves outcomes in patients with stable chest pain |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899446/ https://www.ncbi.nlm.nih.gov/pubmed/31623764 http://dx.doi.org/10.1016/j.jacc.2019.07.085 |
work_keys_str_mv | AT adamsonphilipd guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT williamsmichellec guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT dweckmarcr guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT millsnicholasl guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT boonnicholasa guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT daghemmarwa guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT bingrong guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT mossalastairj guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT mangionkenneth guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT flathermarcus guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT forbesjohn guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT hunteramanda guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT norriejohn guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT shahanoopsv guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT timmisadamd guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT vanbeekedwinjr guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT ahmadiamira guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT leipsicjonathon guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT narulajagat guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT newbydavide guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT roditigiles guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT mcallisterdavida guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT berrycolin guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain AT guidingtherapybycoronaryctangiographyimprovesoutcomesinpatientswithstablechestpain |