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SCOT-HEART: Benefits of CTA strategy in chest pain consistent across subgroups
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The beneficial effect of a coronary CT angiography-based strategy on clinical outcomes compared with standard care in patients with chest pain was consistent across subgroups, and the benefit chiefly occurs because of preventive treatments given to those with stable CAD, according to new data from the SCOT-HEART study.
As Healio previously reported, in the main results of SCOT-HEART, coronary CTA was more likely to reclassify patients as having angina or CHD compared with the usual care, and was associated with a trend toward reduced risk for CHD death or nonfatal MI at 5 years.
For the present analysis, the researchers analyzed the primary endpoint according to symptoms, diagnosis, coronary revascularizations and preventive therapies.
The benefit of the coronary CTA strategy was similar in patients with prior CHD, patients with possible angina and patients without angina and with a normal ECG, Philip D. Adamson, MD, PhD, from Christchurch Heart Institute, University of Otago, New Zealand, and colleagues wrote.
Among patients not diagnosed with angina because of CHD, those assigned to the CTA strategy had a lower incidence rate of the primary outcome (CTA, 0.23 per 100 patient-years; 95% CI, 0.13-0.35; standard care, 0.59 per 100 patient-years; 95% CI, 0.42-0.8), according to the researchers.
Compared with the standard group, the CTA group had higher coronary revascularization rates in the first year (HR = 1.21; 95% CI, 1.01-1.46) but lower rates after the first year (HR = 0.59; 95% CI, 0.38-0.9), Adamson and colleagues wrote.
Preventive therapies, including statins and antiplatelet agents, were prescribed more often in the CTA group than in the standard group (P < .001 for all), with usage highest in those with CAD confirmed by CT, according to the researchers.
“We have presented a multifaceted analysis that consistently and robustly demonstrates the plausibility of a reduction in long-term coronary events consequent on investigating patients with stable chest pain using coronary CTA,” Adamson and colleagues wrote. “If we are to improve the prevention of future myocardial infarction, coronary CTA would appear to be the most effective and indeed the only proven investigative approach in patients with stable chest pain.”
In a related editorial, Cardiology Today Editorial Board Member Leslee J. Shaw, PhD, professor of medicine and radiology at Weill Cornell Medical College, and colleagues wrote that, “If SCOT-HEART patients received more intensified care following identification of significant atherosclerosis, then this fundamentally alters the current diagnostic strategies beyond the identification of high-grade stenosis to include a large proportion of patients with nonobstructive CAD.” – by Erik Swain
Disclosures: Adamson reports no relevant financial disclosures. Shaw reports she holds equity in Cleerly Inc. Please see the study and editorial for the other authors’ relevant financial disclosures.
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