Newby DE, et al. - Researchers investigated the impact of coronary computed tomographic angiography (CTA) on 5-year clinical outcomes in patients with stable chest pain. They found that CTA + standard care vs standard care alone resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years in patients with stable chest pain, with no significantly higher rate of coronary angiography or coronary revascularization.

Methods

• This is an open-label, multicenter, parallel-group trial.
• Researchers randomized 4,146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2,073 patients) or to standard care alone (2,073 patients).
• Three to 7 years of follow-up was done to evaluate investigations, treatments, and clinical outcomes.
• Death from coronary heart disease or nonfatal myocardial infarction at 5 years was assessed as primary end point.

Results

• Ultimately, 20,254 patient-years of follow-up was generated by 4.8 years of median follow-up.
• They reported a lower 5-year rate of the primary end point in the CTA group vs in the standard-care group (2.3% [48 patients] vs 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004).
• First few months of follow-up revealed higher rates of invasive coronary angiography and coronary revascularization in the CTA group vs the standard-care group, but at 5 years these overall rates were comparable: 491 patients in the CTA group and 502 patients in the standard-care group had invasive coronary angiography (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 (hazard ratio, 1.07; 95% CI, 0.91 to 1.27).
• However, findings showed the initiation of more preventive therapies in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as well as more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54).
• No significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause were identified.