Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Cardiovascular Imaging Reports
Published in: Current Cardiovascular Imaging Reports 5/2017

Open Access 01-05-2017 | Cardiac Computed Tomography (T Villines, Section Editor)

Cardiac CT Improves Outcomes in Stable Coronary Heart Disease: Results of Recent Clinical Trials

Authors: Michelle C. Williams, Alastair Moss, Edward Nicol, David E. Newby

Published in: Current Cardiovascular Imaging Reports | Issue 5/2017

Login to get access

Abstract

Purpose of Review

The purpose of this study was to review the recent randomised controlled trials of coronary computed tomography angiography (CCTA) for patients with stable coronary artery disease.

Recent Findings

The initial results and subsequent papers from the SCOT-HEART (Scottish COmputed Tomography of the HEART) and PROMISE (PROspective Multicentre Imaging Study for Evaluation of chest pain) trials have shown that CCTA is a safe and appropriate addition to standard care or alternative to functional testing. The SCOT-HEART study showed that CCTA changes diagnoses, improves diagnostic certainty, changes management, leads to more appropriate use of invasive coronary angiography, and reduces fatal and non-fatal myocardial infarction. A meta-analysis of the four randomised controlled trials showed that CCTA leads to a major reduction in myocardial infarction in patients with stable chest pain.

Summary

CCTA is now an established technique for the assessment of coronary artery disease. Recent ‘test and treat’ randomised controlled trials have shown that CCTA guided changes in management can improve clinical outcomes.
Literature
1.
Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36.CrossRefPubMed
2.
Andreini D, Pontone G, Mushtaq S, et al. A long-term prognostic value of coronary CT angiography in suspected coronary artery disease. J Am Coll Cardiol Img. 2012;5:690–701.CrossRef
3.
Min JK, Shaw LJ, Devereux RB, Okin PM, Weinsaft JW, Russo DJ, Lippolis NJ, Berman DS, Callister TQ. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50:1161–70.CrossRefPubMed
4.
Hadamitzky M, Taubert S, Deseive S, Byrne RA, Martinoff S, Schömig A, Hausleiter J. Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease. Eur Heart J. 2013a; doi:10.​1093/​eurheartj/​eht293.PubMed
5.
Hadamitzky M, Achenbach S, Al-Mallah M, et al. Optimized prognostic score for coronary computed tomographic angiography: results from the CONFIRM registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry). J Am Coll Cardiol. 2013b;62:468–76.CrossRefPubMed
6.
Chow BJW, Small G, Yam Y, et al. Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (Coronary CT aAngiography Evaluation For ClinicalOutcomes: An International Multicenter Registry) registry. Arterioscler Thromb Vasc Biol. 2015;35:981–9.CrossRefPubMedPubMedCentral
7.
Bittencourt MS, Hulten E, Ghoshhajra B, et al. Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circulation: Cardiovascular Imaging. 2014;7:282–91.
8.
•• Douglas PS, Hoffmann U, Patel MR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015a;372:1291–300. Results of the PROMISE study CrossRefPubMedPubMedCentral
9.
Newby DE, Williams MC, Flapan AD, et al. Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic, the Scottish computed tomography of the heart (SCOT-HEART) trial: study protocol for randomized controlled trial. Trials. 2012;13:184.CrossRefPubMedPubMedCentral
10.
•• SCOT-HEART investigators. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet. 2015;385:2383–91. Results of the SCOT-HEART study CrossRef
11.
•• Williams MC, Hunter A, Shah ASV, et al. Use of coronary computed tomographic angiography to guide management of patients with coronary disease. J Am Coll Cardiol. 2016;67:1759–68. Post hoc landmark analysis from the SCOT-HEART study showing a 50% reduction in fatal and non-fatal myocardial infarction CrossRefPubMedPubMedCentral
12.
• McKavanagh P, Lusk L, Ball PA, et al. A comparison of cardiac computerized tomography and exercise stress electrocardiogram test for the investigation of stable chest pain: the clinical results of the CAPP randomized prospective trial. European Heart Journal - Cardiovascular Imaging. 2015;16:441–8. Results of the CAPP study CrossRefPubMed
13.
• Min JK, Koduru S, Dunning AM, et al. Coronary CT angiography versus myocardial perfusion imaging for near-term quality of life, cost and radiation exposure: a prospective multicenter randomized pilot trial. J Cardiovasc Comput Tomogr. 2012;6:274–83. Results of the study by Min et al CrossRefPubMed
14.
• Bittencourt MS, Hulten EA, Murthy VL, Cheezum M, Rochitte CE, Di Carli MF, Blankstein R. Clinical outcomes after evaluation of stable chest pain by coronary computed tomographic angiography versus usual care: a meta-analysis. Circulation: Cardiovascular Imaging. 2016;9:e004419. Meta-analysis of studies of clinical outcomes after evaluation of stable chest pain
15.
Nicol ED, Stirrup J, Leatham E, Roughton M, Underwood SR, Padley SPG, Rubens MB. Clinical management and short-term cost—64-slice MDCT vs. myocardial perfusion scintigraphy. Int J Cardiol. 2010;144:248–50.CrossRefPubMed
16.
Mark DB, Federspiel JJ, Cowper PA, et al. Economic outcomes with anatomical versus functional diagnostic testing for coronary artery disease. Ann Intern Med. 2016a;165:94–102.CrossRefPubMedPubMedCentral
17.
Mark DB, Anstrom KJ, Sheng S, et al. Quality-of-life outcomes with anatomic versus functional diagnostic testing strategies in symptomatic patients with suspected coronary artery disease: results from the PROMISE randomized trial. Circulation. 2016b;133:1995–2007.CrossRefPubMed
18.
Motoyama S, Ito H, Sarai M, et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol. 2015;66:337–46.CrossRefPubMed
19.
Thomsen C, Abdulla J. Characteristics of high-risk coronary plaques identified by computed tomographic angiography and associated prognosis: a systematic review and meta-analysis. European Heart Journal - Cardiovascular Imaging. 2016;17:120–9.CrossRefPubMed
20.
Williams MC, Newby DE. CT myocardial perfusion imaging: current status and future directions. Clin Radiol. 2016;71:739–49.CrossRefPubMed
21.
Douglas PS, Pontone G, Hlatky MA, et al. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFRCT: outcome and resource impacts study. Eur Heart J. 2015b;36:3359–67.CrossRefPubMedPubMedCentral
22.
Gaur S, Øvrehus KA, Dey D, et al. Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions. Eur Heart J. 2016;37:1220–7.CrossRefPubMedPubMedCentral
23.
Bilbey N, Blanke P, Naoum C, Arepalli CD, Nørgaard BL, Leipsic J. Potential impact of clinical use of noninvasive FFRCT on radiation dose exposure and downstream clinical event rate. Clin Imaging. 2016;40:1055–60.CrossRefPubMed
24.
Hlatky MA, De Bruyne B, Pontone G, et al. Quality of life and economic outcomes of assessing fractional flow reserve with computed tomography angiography: the PLATFORM study. J Am Coll Cardiol. 2015;66:2315–23.CrossRefPubMed
Metadata
Title
Cardiac CT Improves Outcomes in Stable Coronary Heart Disease: Results of Recent Clinical Trials
Authors
Michelle C. Williams
Alastair Moss
Edward Nicol
David E. Newby
Publication date
01-05-2017
Publisher
Springer US
Published in
Current Cardiovascular Imaging Reports / Issue 5/2017
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-017-9411-7

Other articles of this Issue 5/2017

Current Cardiovascular Imaging Reports 5/2017 Go to the issue

Cardiac Computed Tomography (T Villines, Section Editor)

The Updated NICE Guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease

Cardiac Nuclear Imaging (A Cuocolo and M Petretta, Section Editors)

Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

Spotlight on CT Imaging (T Schindler, Section Editor)

Role of CT Imaging for Coronary and Non-coronary Interventions

Erratum

Erratum to: Novel Noninvasive Nuclear Medicine Imaging Techniques for Cardiac Inflammation

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits