Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease

In a trial involving 10,003 patients with suspected coronary artery disease, clinical outcomes at 2 years were not improved with an initial strategy of CT angiography, as compared with functional testing (exercise ECG, nuclear stress testing, or stress echocardiography). New-onset, stable chest pain...

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Bibliographic Details
Published in:The New England journal of medicine Vol. 372; no. 14; pp. 1291 - 1300
Main Authors: Douglas, Pamela S, Hoffmann, Udo, Patel, Manesh R, Mark, Daniel B, Al-Khalidi, Hussein R, Cavanaugh, Brendan, Cole, Jason, Dolor, Rowena J, Fordyce, Christopher B, Huang, Megan, Khan, Muhammad Akram, Kosinski, Andrzej S, Krucoff, Mitchell W, Malhotra, Vinay, Picard, Michael H, Udelson, James E, Velazquez, Eric J, Yow, Eric, Cooper, Lawton S, Lee, Kerry L
Format: Journal Article
Language:English
Published: United States Massachusetts Medical Society 02.04.2015
Subjects:
Aged
Angina
Angina, Unstable - epidemiology
Angiography
Cardiac Catheterization
Cardiovascular disease
Catheterization
Chest Pain - etiology
Clinical trials
Computed tomography
Coronary Angiography - adverse effects
Coronary Angiography - methods
Coronary artery
Coronary Artery Disease - diagnosis
Diagnostic tests
Dyspnea
Echocardiography
Echocardiography, Stress - adverse effects
EKG
Electrocardiography
Exercise Test
Female
Follow-Up Studies
Heart diseases
Humans
Kaplan-Meier Estimate
Male
Medical diagnosis
Middle Aged
Mortality
Myocardial infarction
Myocardial Infarction - epidemiology
Pain
Respiration
Tomography, X-Ray Computed
ISSN:0028-4793, 1533-4406
Online Access:Get full text
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Summary:In a trial involving 10,003 patients with suspected coronary artery disease, clinical outcomes at 2 years were not improved with an initial strategy of CT angiography, as compared with functional testing (exercise ECG, nuclear stress testing, or stress echocardiography). New-onset, stable chest pain is a common clinical problem that results in approximately 4 million stress tests annually in the United States in ambulatory patients without diagnosed heart disease. 1 Despite advances in cardiac testing, there is scant information on health-related outcomes and little consensus about which noninvasive test is preferable. 2 – 4 As a result, current patterns of care have been questioned, including the testing of very-low-risk populations 5 and the catheterization of patients who do not have obstructive coronary artery disease (CAD). 6 – 8 The development of coronary computed tomographic angiography (CTA) and its application in this context has the potential to . . .
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A complete list of investigators in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) is provided in the Supplementary Appendix, available at NEJM.org.
ISSN:0028-4793
1533-4406
DOI:10.1056/NEJMoa1415516