title: Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial.
abstract: OBJECTIVE
  To compare the effectiveness and safety of a cardiac computed tomography (CT) algorithm with functional testing in patients with symptoms suggestive of coronary artery disease (CAD).
  
  
  RESULTS
  Between April 2011 and July 2013, 350 patients with stable angina, referred to the outpatient clinic of four Dutch hospitals, were prospectively randomized between cardiac CT and functional testing (2 : 1 ratio). The tiered cardiac CT protocol included a calcium scan followed by CT angiography if the Agatston calcium score was between 1 and 400. Patients with test-specific contraindications were not excluded from study participation. By 1 year, fewer patients randomized to cardiac CT reported anginal complaints (P = 0.012). The cumulative radiation dose was slightly higher in the CT group (6.6 ± 8.7 vs. 6.1 ± 9.3 mSv; P < 0.0001). After 1.2 years, event-free survival was 96.7% for patients randomized to CT and 89.8% for patients randomized to functional testing (P = 0.011). After CT, the final diagnosis was established sooner (P < 0.0001), and additional downstream testing was required less frequently (25 vs. 53%, P < 0.0001), resulting in lower cumulative diagnostic costs (€369 vs. €440; P < 0.0001).
  
  
  CONCLUSIONS
  For patients with suspected stable CAD, a tiered cardiac CT protocol offers an effective and safe alternative to functional testing. Incorporating the calcium scan into the diagnostic workup was safe and lowered diagnostic expenses and radiation exposure.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Room Ca-207a, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands m.m.lubbers@erasmusmc.nl.
authors.forename: Marisa
authors.initials: M
authors.lastname: Lubbers
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Room Ca-207a, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Admir
authors.initials: A
authors.lastname: Dedic
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Room Ca-207a, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Coenen
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Room Ca-207a, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Tjebbe
authors.initials: T
authors.lastname: Galema
authors.affiliation: Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors.forename: Jurgen
authors.initials: J
authors.lastname: Akkerhuis
authors.affiliation: Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Tobias
authors.initials: T
authors.lastname: Bruning
authors.affiliation: Department of Cardiology, Haven Hospital, Rotterdam, The Netherlands.
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Krenning
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Room Ca-207a, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Musters
authors.affiliation: Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ouhlous
authors.affiliation: Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors.forename: Ahno
authors.initials: A
authors.lastname: Liem
authors.affiliation: Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Andre
authors.initials: A
authors.lastname: Niezen
authors.affiliation: Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Miriam
authors.initials: M
authors.lastname: Hunink
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Room Ca-207a, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: de Feijter
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Room Ca-207a, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Koen
authors.initials: K
authors.lastname: Nieman
mesh_terms: D000072226:Computed Tomography Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D011829:Radiation Dosage; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy
keywords: CT calcium scan; Clinical trials; Coronary CT angiography; Diagnostic testing; Functional testing; Stable angina