Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease

SCOT-HEART Investigators; Michelle C. Williams; Amanda Hunter; Anoop S. V. Shah; Valentina Assi; Stephanie Lewis; Joel Smith; Colin Berry; Nicholas A. Boon; Elizabeth Clark; Marcus Flather; John Forbes; Scott McLean; Giles Roditi; Edwin J. R. van Beek; Adam D. Timmis; David E. Newby; Kat Oatey

doi:10.1016/j.jacc.2016.02.026

Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease

SCOT-HEART Investigators, Michelle C. Williams, Amanda Hunter, Anoop S. V. Shah, Valentina Assi, Stephanie Lewis, Joel Smith, Colin Berry, Nicholas A. Boon, Elizabeth Clark, Marcus Flather, John Forbes, Scott McLean, Giles Roditi, Edwin J. R. van Beek, Adam D. Timmis, David E. Newby^*, Kat Oatey (Member of Group Organisation)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

BACKGROUND In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA).

OBJECTIVES The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes.

METHODS In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records.

RESULTS Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p <0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p <0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621).

CONCLUSIONS In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)

Original language	English
Pages (from-to)	1759-1768
Number of pages	10
Journal	Journal of the American College of Cardiology
Volume	67
Issue number	15
Early online date	11 Apr 2016
DOIs	https://doi.org/10.1016/j.jacc.2016.02.026
Publication status	Published - 19 Apr 2016

Keywords / Materials (for Non-textual outputs)

angina pectoris
invasive coronary angiography
myocardial infarction
preventive therapy
ARTERY-DISEASE
MYOCARDIAL-INFARCTION
CT ANGIOGRAPHY
HEART-DISEASE
RANDOMIZED-TRIALS
CLINICAL-OUTCOMES
RISK-FACTORS
SCOT-HEART
CHOLESTEROL
THERAPY

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David Newby
- d.e.newbyed.acuk
- Deanery of Clinical Sciences - BHF Duke of Edinburgh Chair of Cardiology
- Centre for Cardiovascular Science
- Edinburgh Imaging
Person: Academic: Research Active
Edwin van Beek
- edwin-vanbeeked.acuk
- Deanery of Clinical Sciences - SINAPSE Chair of Clinical Radiology
- Edinburgh Neuroscience
- Edinburgh Imaging
- Centre for Cardiovascular Science
Person: Academic: Research Active

Cite this

SCOT-HEART Investigators, Williams, M. C., Hunter, A., Shah, A. S. V., Assi, V., Lewis, S., Smith, J., Berry, C., Boon, N. A., Clark, E., Flather, M., Forbes, J., McLean, S., Roditi, G., van Beek, E. J. R., Timmis, A. D., Newby, D. E., & Oatey, K. (2016). Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease. Journal of the American College of Cardiology, 67(15), 1759-1768. https://doi.org/10.1016/j.jacc.2016.02.026

@article{d6e6e4c761894e9a8c04bf45b7e1370e,

title = "Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease",

abstract = "BACKGROUND In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA).OBJECTIVES The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes.METHODS In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records.RESULTS Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p <0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p <0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621).CONCLUSIONS In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590) ",

keywords = "angina pectoris, invasive coronary angiography, myocardial infarction, preventive therapy, ARTERY-DISEASE, MYOCARDIAL-INFARCTION, CT ANGIOGRAPHY, HEART-DISEASE, RANDOMIZED-TRIALS, CLINICAL-OUTCOMES, RISK-FACTORS, SCOT-HEART, CHOLESTEROL, THERAPY",

author = "{SCOT-HEART Investigators} and Williams, {Michelle C.} and Amanda Hunter and Shah, {Anoop S. V.} and Valentina Assi and Stephanie Lewis and Joel Smith and Colin Berry and Boon, {Nicholas A.} and Elizabeth Clark and Marcus Flather and John Forbes and Scott McLean and Giles Roditi and {van Beek}, {Edwin J. R.} and Timmis, {Adam D.} and Newby, {David E.} and Kat Oatey",

year = "2016",

month = apr,

day = "19",

doi = "10.1016/j.jacc.2016.02.026",

language = "English",

volume = "67",

pages = "1759--1768",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Science",

number = "15",

}

SCOT-HEART Investigators, Williams, MC, Hunter, A, Shah, ASV, Assi, V, Lewis, S, Smith, J, Berry, C, Boon, NA, Clark, E, Flather, M, Forbes, J, McLean, S, Roditi, G, van Beek, EJR, Timmis, AD, Newby, DE & Oatey, K 2016, 'Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease', Journal of the American College of Cardiology, vol. 67, no. 15, pp. 1759-1768. https://doi.org/10.1016/j.jacc.2016.02.026

TY - JOUR

T1 - Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease

AU - SCOT-HEART Investigators

AU - Williams, Michelle C.

AU - Hunter, Amanda

AU - Shah, Anoop S. V.

AU - Assi, Valentina

AU - Lewis, Stephanie

AU - Smith, Joel

AU - Berry, Colin

AU - Boon, Nicholas A.

AU - Clark, Elizabeth

AU - Flather, Marcus

AU - Forbes, John

AU - McLean, Scott

AU - Roditi, Giles

AU - van Beek, Edwin J. R.

AU - Timmis, Adam D.

AU - Newby, David E.

A2 - Oatey, Kat

PY - 2016/4/19

Y1 - 2016/4/19

N2 - BACKGROUND In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA).OBJECTIVES The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes.METHODS In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records.RESULTS Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p <0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p <0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621).CONCLUSIONS In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)

AB - BACKGROUND In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA).OBJECTIVES The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes.METHODS In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records.RESULTS Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p <0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p <0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621).CONCLUSIONS In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590)

KW - angina pectoris

KW - invasive coronary angiography

KW - myocardial infarction

KW - preventive therapy

KW - ARTERY-DISEASE

KW - MYOCARDIAL-INFARCTION

KW - CT ANGIOGRAPHY

KW - HEART-DISEASE

KW - RANDOMIZED-TRIALS

KW - CLINICAL-OUTCOMES

KW - RISK-FACTORS

KW - SCOT-HEART

KW - CHOLESTEROL

KW - THERAPY

U2 - 10.1016/j.jacc.2016.02.026

DO - 10.1016/j.jacc.2016.02.026

M3 - Article

C2 - 27081014

SN - 0735-1097

VL - 67

SP - 1759

EP - 1768

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 15

ER -

Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease

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Keywords / Materials (for Non-textual outputs)

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