BACKGROUND: Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic testing, although there are limited data from randomized trials to guide care. METHODS: We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. RESULTS: The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P=0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was functional testing (3.4% vs. 4.3%, P=0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the functional-testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the functional-testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). CONCLUSIONS: In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the National Heart, Lung, and Blood Institute; PROMISE ClinicalTrials.gov number, NCT01174550.).
RCT Entities:
BACKGROUND: Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic testing, although there are limited data from randomized trials to guide care. METHODS: We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. RESULTS: The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P=0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was functional testing (3.4% vs. 4.3%, P=0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the functional-testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the functional-testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). CONCLUSIONS: In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the National Heart, Lung, and Blood Institute; PROMISE ClinicalTrials.gov number, NCT01174550.).
Authors: Scott M Grundy; James I Cleeman; Stephen R Daniels; Karen A Donato; Robert H Eckel; Barry A Franklin; David J Gordon; Ronald M Krauss; Peter J Savage; Sidney C Smith; John A Spertus; Fernando Costa Journal: Circulation Date: 2005-09-12 Impact factor: 29.690
Authors: Thomas C Gerber; J Jeffrey Carr; Andrew E Arai; Robert L Dixon; Victor A Ferrari; Antoinette S Gomes; Gary V Heller; Cynthia H McCollough; Michael F McNitt-Gray; Fred A Mettler; Jennifer H Mieres; Richard L Morin; Michael V Yester Journal: Circulation Date: 2009-02-02 Impact factor: 29.690
Authors: Caroline A Daly; Bianca De Stavola; Jose L Lopez Sendon; Luigi Tavazzi; Eric Boersma; Felicity Clemens; Nicholas Danchin; Francois Delahaye; Anselm Gitt; Desmond Julian; David Mulcahy; Witold Ruzyllo; Kristian Thygesen; Freek Verheugt; Kim M Fox Journal: BMJ Date: 2006-01-13
Authors: Karen A Hicks; James E Tcheng; Biykem Bozkurt; Bernard R Chaitman; Donald E Cutlip; Andrew Farb; Gregg C Fonarow; Jeffrey P Jacobs; Michael R Jaff; Judith H Lichtman; Marian C Limacher; Kenneth W Mahaffey; Roxana Mehran; Steven E Nissen; Eric E Smith; Shari L Targum Journal: J Am Coll Cardiol Date: 2014-12-29 Impact factor: 24.094
Authors: Joseph B Muhlestein; Donald L Lappé; Joao A C Lima; Boaz D Rosen; Heidi T May; Stacey Knight; David A Bluemke; Steven R Towner; Viet Le; Tami L Bair; Andrea L Vavere; Jeffrey L Anderson Journal: JAMA Date: 2014-12-03 Impact factor: 56.272
Authors: W Bob Meijboom; Matthijs F L Meijs; Joanne D Schuijf; Maarten J Cramer; Nico R Mollet; Carlos A G van Mieghem; Koen Nieman; Jacob M van Werkhoven; Gabija Pundziute; Annick C Weustink; Alexander M de Vos; Francesca Pugliese; Benno Rensing; J Wouter Jukema; Jeroen J Bax; Mathias Prokop; Pieter A Doevendans; Myriam G M Hunink; Gabriel P Krestin; Pim J de Feyter Journal: J Am Coll Cardiol Date: 2008-12-16 Impact factor: 24.094
Authors: Matthew J Budoff; David Dowe; James G Jollis; Michael Gitter; John Sutherland; Edward Halamert; Markus Scherer; Raye Bellinger; Arthur Martin; Robert Benton; Augustin Delago; James K Min Journal: J Am Coll Cardiol Date: 2008-11-18 Impact factor: 24.094
Authors: Alexander R van Rosendael; A Maxim Bax; Jeff M Smit; Inge J van den Hoogen; Xiaoyue Ma; Subhi Al'Aref; Stephan Achenbach; Mouaz H Al-Mallah; Daniele Andreini; Daniel S Berman; Matthew J Budoff; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Kavitha Chinnaiyan; Benjamin J W Chow; Ricardo C Cury; Augustin DeLago; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Philipp A Kaufmann; Yong-Jin Kim; Jonathon A Leipsic; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Gianluca Pontone; Gilbert L Raff; Ronen Rubinshtein; Todd C Villines; Heidi Gransar; Yao Lu; Jessica M Peña; Fay Y Lin; Leslee J Shaw; James K Min; Jeroen J Bax Journal: Eur Heart J Cardiovasc Imaging Date: 2020-05-01 Impact factor: 6.875
Authors: Stacey Knight; David B Min; Viet T Le; Kent G Meredith; Ritesh Dhar; Santanu Biswas; Kurt R Jensen; Steven M Mason; Jon-David Ethington; Donald L Lappe; Joseph B Muhlestein; Jeffrey L Anderson; Kirk U Knowlton Journal: JCI Insight Date: 2018-05-03
Authors: Arthur E Stillman; Matthijs Oudkerk; David A Bluemke; Menko Jan de Boer; Jens Bremerich; Ernest V Garcia; Matthias Gutberlet; Pim van der Harst; W Gregory Hundley; Michael Jerosch-Herold; Dirkjan Kuijpers; Raymond Y Kwong; Eike Nagel; Stamatios Lerakis; John Oshinski; Jean-François Paul; Riemer H J A Slart; Vinod Thourani; Rozemarijn Vliegenthart; Bernd J Wintersperger Journal: Int J Cardiovasc Imaging Date: 2018-03-19 Impact factor: 2.357