CT angiography for patients with chest pain reduces mortality, heart attacks

A new study suggests coronary CT angiography (CTA), in addition to standard care in patients with stable chest pain, lowers death rates from coronary heart disease (CHD) or nonfatal myocardial (MI) infarction at five years, compared to standard care alone. This method of treatment does not result in a significantly higher rate of coronary angiography or coronary revascularization.

Results of the study were published in the New England Journal of Medicine.

The SCOT-HEART trial researchers, led by David E. Newby, MD, of the University of Edinburgh in Scotland, sought to determine coronary CTA's impact on five-year clinical outcomes in individuals with stable chest pain.

“In our previous report from the SCOT-HEART trial, we found that the use of CTA had a significant effect on the diagnosis and treatment of patients who had been referred for evaluation of stable chest pain, in that it influenced both the certainty and the frequency of the diagnosis of coronary heart disease and led to alterations in management,” Newby and colleagues wrote.

The researchers randomly assigned more than 4,100 patients with stable chest pain to receive standard care in addition to CTA or standard care alone to determine their five-year clinical outcome. End points for the study included death from CHD or nonfatal MI. During an average follow up time of 4.8 years, they found:

  • CTA patients were 40 percent more likely to begin preventive therapies compared to standard care patients.
  • CTA patients were 27 percent more likely to begin antianginal therapies.
  • There was no significant difference in the frequency of invasive coronary angiography or coronary revascularization in both groups at the five-year mark. There were 491 invasive coronary angiographies performed in the CTA group and 502 in the standard care group. There were 279 coronary revascularizations performed in 279 patients in the CTA group and 267 in the standard care group.
  • CTA patients had lower death rates from CHD or nonfatal MI.

The researchers noted all patients appeared to derive similar benefits from CTA. They also questioned if more widespread testing may be helpful, regardless of symptoms. Their data suggests 63 patients with stable chest pain would need to be referred for CTA to prevent one fatal or nonfatal MI over the course of five years.

“Our findings suggest that the use of CTA resulted in more correct diagnoses of coronary heart disease than standard care alone, which, in turn, led to the use of appropriate therapies, and this change in management resulted in fewer clinical events in the CTA group than in the standard-care group,” Newby et al. wrote.