Coronary CT Angiography and 5-Year Risk of Myocardial Infarction
Open accessAbstract
BACKGROUND: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. METHODS: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than 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). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (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, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. CONCLUSIONS: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .).
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The SCOT-HEART trial was an open-label randomized comparison of coronary computed tomography angiography with standard care in 4146 subjects with stable chest pain (444 with diabetes mellitus) from 2010 to 2014.
“The SCOT-HEART trial (Scottish Computed Tomography of the Heart) was an open-label randomized comparison of CTA with standard care (which could include stress testing, angiography, or continued medical management) in 4146 subjects with stable chest pain (444 with diabetes mellitus) from 2010 to 2014.”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [230]
In SCOT-HEART, revascularization rates were similar in the two groups and probably did not play a major role in the difference in the primary end point.
“Revascularization rates were similar in the 2 groups and probably did not play a major role in the difference between the groups in the rate of the primary end point.”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [230]
In SCOT-HEART, the effect was similar in the subset of patients with diabetes mellitus (primary end point HR, 0.36 [95% CI, 0.15-0.87]).
“This effect was similar in the subset of patients with diabetes mellitus (primary end point HR, 0.36 [95% CI, 0.15–0.87]).”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [230]
In SCOT-HEART, the difference was caused primarily by a lower rate of nonfatal myocardial infarction in the CTA group than in the standard care group (HR, 0.60 [95% CI, 0.41-0.87]).
“This difference was caused primarily by a lower rate of nonfatal myocardial infarction in the CTA group than in the standard care group (HR, 0.60 [95% CI, 0.41–0.87]).”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [230]
At 5-year follow-up in SCOT-HEART, the rate of the composite end point of death caused by coronary artery disease or nonfatal myocardial infarction was lower in the CTA group than in the standard care group (2.3% versus 3.9%; HR, 0.59 [95% CI, 0.41-0.84]; P=0.004).
“At the 5-year follow-up, the rate of the composite end point of death caused by CAD or nonfatal myocardial infarction was lower in the CTA group than in the standard care group (2.3% versus 3.9%; HR, 0.59 [95% CI, 0.41–0.84]; P=0.004).”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [230]
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- Authors
- The SCOT-HEART Investigators
- Affiliations
- University of Edinburgh (GB)
- Corresponding author
- The SCOT-HEART Investigators
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2018-09-06
- Volume
- 379
- Issue
- 10
- Pages
- 924-933
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2892274298
- Cited by
- 1,390
- References
- 32
- Citations by year
- 2026: 138 · 2025: 159 · 2024: 171 · 2023: 197 · 2022: 164 · 2021: 211 · 2020: 182 · 2019: 142 · 2018: 26
- FWCI
- 96.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion, other-oa)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Funders
- Chief Scientist Office (CZH/4/588)
- British Heart Foundation (CH/09/002, RE/13/3/30183)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- coronary CT angiography, myocardial infarction, coronary heart disease mortality, stable chest pain, coronary revascularization, invasive coronary angiography, prophylaxis, antianginal therapy, coronary artery disease diagnosis, standard of care comparison, cardiovascular risk stratification
- MeSH terms
- Computed Tomography Angiography, Adult, Aged, Chest Pain, Coronary Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Risk, Incidence, Coronary Angiography, Percutaneous Coronary Intervention
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