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Guiding therapy by coronary CT angiography improves outcomes in patients with stable chest pain

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dc.contributor.author Adamson, Philip D.
dc.contributor.author Williams, Michelle C.
dc.contributor.author Dweck, Marc R.
dc.contributor.author Mills, Nicholas L.
dc.contributor.author Boon, Nicholas A.
dc.contributor.author Daghem, Marwa
dc.contributor.author Bing, Rong
dc.contributor.author Moss, Alastair J.
dc.contributor.author Mangion, Kenneth
dc.contributor.author Flather, Marcus
dc.contributor.author Forbes, John F.
dc.contributor.author Hunter, Amanada
dc.contributor.author Norrie, John
dc.contributor.author Shah, Anoop S.V.
dc.contributor.author Timmis, Adam D.
dc.contributor.author van Beek, Edwin J.R.
dc.contributor.author Ahmandi, Amir A.
dc.contributor.author Leipsic, Jonathon
dc.contributor.author Narula, Jagat
dc.contributor.author Newby, David E.
dc.contributor.author Roditi, Giles
dc.contributor.author McAllister, David A.
dc.contributor.author Berry, Colin
dc.date.accessioned 2019-11-27T15:02:48Z
dc.date.available 2019-11-27T15:02:48Z
dc.date.issued 2019
dc.identifier.uri http://hdl.handle.net/10344/8269
dc.description peer-reviewed en_US
dc.description.abstract 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 ¼ 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 patientyears; 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 ¼ 0.042) but lower beyond 1 year (HR: 0.59; 95% CI: 0.38 to 0.90; p ¼ 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 en_US
dc.language.iso eng en_US
dc.publisher Elsevier en_US
dc.relation.ispartofseries Journal of the American College of Cardiology;74 (16), pp. 2058-2070
dc.relation.uri https://doi.org/10.1016/j.jacc.2019.07.085
dc.subject angina pectoris en_US
dc.subject computed tomography en_US
dc.subject coronary heart disease en_US
dc.title Guiding therapy by coronary CT angiography improves outcomes in patients with stable chest pain en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1016/j.jacc.2019.07.085
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 2930415


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