Coronary CT Angiography (CCTA) Trial Suggests Lowered risk of Death from Coronary Artery Disease
Wednesday, September 12, 2018
Posted by: Claire Johns
Coronary CT Angiography (CCTA), in addition to standard care, was associated with a 41% lower subsequent risk of nonfatal myocardial infarction or death from coronary artery disease than standard care alone, according to a study published on August 25 in New England Journal of Medicine.
A five-year follow-up study of the Scottish Computed Tomography of the Heart (SCOT-HEART) trial included outcomes for over 4,000 patients whom clinicians had referred for chest pain assessment at one of 12 cardiology centers in the U.K. and Ireland. Half of the patients (2,073) received a routine evaluation, and half of the patients received a CCTA exam in addition. The results indicated a significant reduction in heart attack and death in the group that received the CCTA exam. The rate of death from coronary artery disease or nonfatal heart attack lowered from 3.9% with the group that received standard care, to 2.3% of the group that received the CCTA exam.
David Newby, MD, PhD of the University of Edinburgh, who led the study, reflected on the results of the trial, saying, “It is nice to be able to show an admitting trail that makes an impact and a difference on outcomes. This is the first time we have been able to do that with a noninvasive test.”
CCTA’s exam usage rate for radiologists has steadily risen since 2006. David C. Levin, MD and his colleagues at Thomas Jefferson University researched the usage of CCTA in clinical practices from 2007 to 2016, which showed an increase in all settings with the exception of private offices. The CCTA usage rate per 100,000 Medicare beneficiaries increased for hospital outpatients from 18 to 25.6 for cardiologists and from 26.2 to 43 for radiologists.
Several major studies, such as SCOT-HEART and the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE), have shown concrete evidence linking CCTA to improved diagnosis of obstructive coronary artery disease as well as reduced adverse event rates, compared with standard care. The expectation is that CCTA will assist patients with the implementation of lifestyle modifications and preventive therapies to decrease their risk for nonfatal heart attack.
The randomization method of the SCOT-HEART trial balanced patient characteristics such as age, sex, and history of heart disease. The researchers also prompted the physicians caring for the patients to manage each condition using all available information, including results from the CCTA exams.
Moving forward, Dr. Newby recommends including lifestyle alterations data in future trials. “Whether you smoke or not, whether you have a healthy diet, whether you exercise — we didn’t capture that data, but we plan to do so in the future. I think the overall benefit is quite clear from the trial. It’s incontrovertible”.
Suhny Abbara, MD, FSCCT, president of the Society of Cardiovascular Computed Tomography (SCCT) stated, “The SCOT-HEART trial is another important milestone in the development of evidence to support the use of cardiovascular CT.” He added: “The trial demonstrates a drastic reduction in the incidence of myocardial infarction and death, further establishing cardiovascular CT as a clinically proven test that can positively impact the work of our members, helping them develop and adopt prevention strategies for their patients that save lives.”