Abstract / Description of output
Background
Computed tomography coronary angiography (CTCA) offers detailed assessment of the presence of coronary atherosclerosis and helps guide patient management. We investigated influences of early CTCA on the subsequent use of preventative treatment in patients with suspected acute coronary syndrome.
Methods
In this secondary analysis of a multicentre randomised controlled trial of early CTCA in intermediate-risk patients with suspected acute coronary syndrome, prescription of aspirin, P2Y12 receptor antagonist, statin, renin–angiotensin system blocker, and beta-blocker therapies from randomisation to discharge were compared within then between those randomised to early CTCA or to standard of care only. Effects of CTCA findings on adjustment of these therapies were further examined.
Results
In 1743 patients (874 randomised to early CTCA and 869 to standard of care only), prescription of P2Y12 receptor antagonist, dual antiplatelet, and statin therapies
increased more in the early CTCA group (between-group difference: 4.6% (95%
confidence interval, 0.3 to 8.9), 4.5% (95% confidence interval, 0.2 to 8.7), and 4.3% (95% confidence interval, 0.2 to 8.5), respectively), whereas prescription of other preventative therapies increased by similar extent in both study groups. Amongst patients randomised to early CTCA, there were additional increments of preventative treatment in those with obstructive coronary artery disease and higher rates of 6 reductions in antiplatelet and beta-blocker therapies in those with normal coronary arteries.
Conclusions
Prescription patterns of preventative treatment varied during index hospitalisation in patients with suspected acute coronary syndrome. Early CTCA facilitated targeted individualisation of these therapies based on the extent of coronary artery disease.
Computed tomography coronary angiography (CTCA) offers detailed assessment of the presence of coronary atherosclerosis and helps guide patient management. We investigated influences of early CTCA on the subsequent use of preventative treatment in patients with suspected acute coronary syndrome.
Methods
In this secondary analysis of a multicentre randomised controlled trial of early CTCA in intermediate-risk patients with suspected acute coronary syndrome, prescription of aspirin, P2Y12 receptor antagonist, statin, renin–angiotensin system blocker, and beta-blocker therapies from randomisation to discharge were compared within then between those randomised to early CTCA or to standard of care only. Effects of CTCA findings on adjustment of these therapies were further examined.
Results
In 1743 patients (874 randomised to early CTCA and 869 to standard of care only), prescription of P2Y12 receptor antagonist, dual antiplatelet, and statin therapies
increased more in the early CTCA group (between-group difference: 4.6% (95%
confidence interval, 0.3 to 8.9), 4.5% (95% confidence interval, 0.2 to 8.7), and 4.3% (95% confidence interval, 0.2 to 8.5), respectively), whereas prescription of other preventative therapies increased by similar extent in both study groups. Amongst patients randomised to early CTCA, there were additional increments of preventative treatment in those with obstructive coronary artery disease and higher rates of 6 reductions in antiplatelet and beta-blocker therapies in those with normal coronary arteries.
Conclusions
Prescription patterns of preventative treatment varied during index hospitalisation in patients with suspected acute coronary syndrome. Early CTCA facilitated targeted individualisation of these therapies based on the extent of coronary artery disease.
| Original language | English |
|---|---|
| Journal | American Heart Journal |
| Publication status | Published - 16 Oct 2023 |