title: A comparison of cardiac computerized tomography and exercise stress electrocardiogram test for the investigation of stable chest pain: the clinical results of the CAPP randomized prospective trial.
abstract: OBJECTIVE
  To determine the symptomatic and prognostic differences resulting from a novel diagnostic pathway based on cardiac computerized tomography (CT) compared with the traditional exercise stress electrocardiography test (EST) in stable chest pain patients.
  
  
  RESULTS
  A prospective randomized controlled trial compared selected patient outcomes in EST and cardiac CT coronary angiography groups. Five hundred patients with troponin-negative stable chest pain and without known coronary artery disease were recruited. Patients completed the Seattle Angina Questionnaires (SAQ) at baseline, 3, and 12 months to assess angina symptoms. Patients were also followed for management strategies and clinical events. Over the year 12 patients withdrew, resulting in 245 in the EST cohort and 243 in the CT cohort. There was no significant difference in baseline demographics. The CT arm had a statistical difference in angina stability and quality-of-life domains of the SAQ at 3 and12 months, suggesting less angina compared with the EST arm. In the CT arm, there was more significant disease identified and more revascularizations. Significantly, more inconclusive results were seen in the EST arm with a higher number of additional investigations ordered. There was also a longer mean time to management. There were no differences in major adverse cardiac events between the cohorts. At 1 year in the EST arm, there were more Accident and Emergency (A&E) attendances and cardiac admission.
  
  
  CONCLUSIONS
  Cardiac CT as an index investigation for stable chest pain improved angina symptoms and resulted in fewer investigations and re-hospitalizations compared with EST.
  
  
  BACKGROUND
  http://www.controlled-trials.com/ISRCTN52480460.
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK Centre for Vision and Vascular Science, Institute of Clinical Science A, Queen's University Belfast, Royal Victoria Hospital Belfast, Belfast BT126BA, UK mckavanagh@doctors.net.uk.
authors.forename: P
authors.initials: P
authors.lastname: McKavanagh
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK.
authors.forename: L
authors.initials: L
authors.lastname: Lusk
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Ball
authors.affiliation: The Northern Ireland Clinical Trials Unit, Education and Research Centre, Royal Hospitals, Belfast BT12 6BA, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Verghis
authors.affiliation: The Northern Ireland Clinical Trials Unit, Education and Research Centre, Royal Hospitals, Belfast BT12 6BA, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Agus
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK.
authors.forename: T R
authors.initials: TR
authors.lastname: Trinick
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK.
authors.forename: E
authors.initials: E
authors.lastname: Duly
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK.
authors.forename: G M
authors.initials: GM
authors.lastname: Walls
authors.affiliation: The Northern Ireland Clinical Trials Unit, Education and Research Centre, Royal Hospitals, Belfast BT12 6BA, UK.
authors.forename: M
authors.initials: M
authors.lastname: Stevenson
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK.
authors.forename: B
authors.initials: B
authors.lastname: James
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK.
authors.forename: A
authors.initials: A
authors.lastname: Hamilton
authors.affiliation: Centre for Vision and Vascular Science, Institute of Clinical Science A, Queen's University Belfast, Royal Victoria Hospital Belfast, Belfast BT126BA, UK.
authors.forename: M T
authors.initials: MT
authors.lastname: Harbinson
authors.affiliation: Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK Centre for Vision and Vascular Science, Institute of Clinical Science A, Queen's University Belfast, Royal Victoria Hospital Belfast, Belfast BT126BA, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Donnelly
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: cardiac computerized tomography; exercise stress electrocardiogram; stable chest pain