Cited by 1,390Cardiac Imaging and DiagnosticsCoronary Interventions and DiagnosticsAcute Myocardial Infarction Research

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Coronary CT Angiography and 5-Year Risk of Myocardial Infarction

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The SCOT-HEART Investigators·2018·New England Journal of Medicine

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Abstract

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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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
DOI: 10.1056/nejmoa1805971
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
Licence: www.nejmgroup.org/legal/terms-of-use.htm (vor)
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 › Cardiology and Cardiovascular Medicine › 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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Coronary CT Angiography and 5-Year Risk of Myocardial Infarction

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