Clinical risk prediction, coronary computed tomography angiography, and cardiovascular events in new-onset chest pain: the PROMISE and SCOT-HEART trials.

Autor:	Rasmussen LD; Department of Cardiology, Gødstrup Hospital, Herning, Denmark.; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark., Schmidt SE; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark., Knuuti J; Heart Center, Turku University Hospital, Turku, Finland.; Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland., Vrints C; Research Group Cardiovascular Diseases, Department GENCOR, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.; Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium., Bøttcher M; Department of Cardiology, Gødstrup Hospital, Herning, Denmark., Foldyna B; Cardiovascular Imaging Research Center, Department of Radiology, Mass. General Hospital-Harvard Medical School, Boston, MA, USA., Williams MC; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK., Newby DE; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK., Douglas PS; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA., Winther S; Department of Cardiology, Gødstrup Hospital, Herning, Denmark.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Oct 25. Date of Electronic Publication: 2024 Oct 25.
DOI:	10.1093/eurheartj/ehae742
Abstrakt:	Background and Aims: Whether index testing using coronary computed tomography angiography (CTA) improves outcomes in stable chest pain is debated. The risk factor weighted clinical likelihood (RF-CL) model provides likelihood estimation of obstructive coronary artery disease. This study investigated the prognostic effect of coronary CTA vs. usual care by RF-CL estimates. Methods: Large-scale studies randomized patients (N = 13 748) with stable chest pain to coronary CTA as part of the initial work-up in addition to or instead of usual care including functional testing. Patients were stratified according to RF-CL estimates [RF-CL: very-low (≤5%), low (>5%-15%), and moderate/high (>15%)]. The primary endpoint was myocardial infarction or death at 3 years. Results: The primary endpoint occurred in 313 (2.3%) patients. Event rates were similar in patients allocated to coronary CTA vs. usual care [risk difference (RD) 0.3%, hazard ratio (HR) 0.84 (95% CI 0.67-1.05)]. Overall, 33%, 44%, and 23% patients had very-low, low, and moderate/high RF-CL. Risk was similar in patients with very low and moderate/high RF-CL allocated to coronary CTA vs. usual care [very low: RD 0.3%, HR 1.27 (0.74-2.16); moderate/high: RD 0.5%, HR 0.88 (0.63-1.23)]. Conversely, patients with low RF-CL undergoing coronary CTA had lower event rates [RD 0.7%, HR 0.67 (95% CI 0.47-0.97)]. The number needed to test using coronary CTA to prevent one event within 3 years was 143. Conclusions: Despite an overall good prognosis, low RF-CL patients have reduced risk of myocardial infarction or death when allocated to coronary CTA vs. usual care. Risk is similar in patients with very-low and moderate/high likelihood. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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