A new study finds that the use of computed tomographic angiography (CTA) in addition to the standard care in patients with stable chest pain reduces the risk of death from coronary heart disease or heart attack at 5 years versus standard care alone. The study, published in the journal New England Journal of Medicine, is the first of its kind to look at the impact of the scans on long-term survival rates.
The life-saving scans helped to spot those with heart disease so they could be given treatments to prevent heart attacks. Researchers say current guidelines should be updated to incorporate the scans into routine care.
Previous studies have shown the relevance of CTA in improving the diagnostic certainty in the assessment of patients with stable chest pain. David Newby, professor, BHF Centre for Cardiovascular Science at the University of Edinburgh, and colleagues conducted the study to determine the effect of CTA on 5-year clinical outcomes.
Patients who are at risk of a heart attack are frequently diagnosed with a test called an angiogram. This involves inserting tubes into the body and heart to check the flow of blood and identify any obstructions that could pose a heart attack risk.
CTA scans enable doctors to look at the blood vessels from the outside the body, without the need to insert tubes into the heart. The scans are cheaper, quicker and safer than angiograms.
The SCOT-HEART involved analysis of more than 4000 patients with stable chest pain who were referred to a hospital clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary endpoint was death from coronary heart disease or nonfatal myocardial infarction at 5 years.
- The 5-year rate of the primary endpoint was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients].
- Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group.
- More preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54).
- There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause.
Results indicate that after receiving the scan, the number of patients suffering a heart attack within five years dropped by 40 percent.
The number of patients undergoing additional procedures increased within the first year but had levelled out by the end of the five-year period. This suggests that including the scans in routine care would not lead to a surge in costly tests or additional heart surgery, the researchers say.
“This relatively simple heart scan ensures that patients get the right treatment. This is the first time that CT guided management has been shown to improve patient outcomes with a major reduction in the future risk of heart attacks. This has major implications for how we now investigate and manage patients with suspected heart disease.” said Dr. Newby.
“This study demonstrates that the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization,” concluded the auhtors.
For further reference follow the link: 10.1056/NEJMoa1805971