Another Building Block in the Wall (Dr. Jonathon Leipsic)
Last year, the SCOT-HEART trial (Scottish COmputed Tomography of the HEART) demonstrated that coronary computed tomography angiography (CCTA) markedly clarified diagnoses for patients with suspected angina due to coronary heart disease (Lancet 2015;385:2383-91). Whether CCTA-guided changes in diagnoses led to appropriate improvements in invasive coronary angiography and initiation of preventive treatments, and whether these changes could be attributable to an improvement in clinical outcome, were unanswered questions. Now, a sub-analysis of SCOT-HEART has provided answers that may change how coronary artery disease (CAD) is diagnosed and managed (J Am Coll Cardiol 2016;67:1759-68).
The SCOT-HEART sub-analysis showed that CCTA-guided therapeutic decision-making ultimately led to a 50 percent reduction in fatal and non-fatal myocardial infarction when compared to usual care, largely including stress testing. Although these findings will require future validation, they suggest that CCTA should be strongly considered as the first-line test for patients presenting with stable chest pain and no known CAD.
“With SCOT-HEART, we have moved beyond studies of diagnostic accuracy,” wrote Michelle C. Williams, MD, MBChB, of the British Heart Foundation Centre for Cardiovascular Science at the University of Edinburgh in Scotland and lead author of the sub-analysis. “This study will certainly change practice.”
Dr. Jonathon Leipsic writes