title: Diagnostic Strategies for the Evaluation of Chest Pain: Clinical Implications From SCOT-HEART and PROMISE.
abstract: SCOT-HEART (Scottish COmputed Tomography of the HEART) and PROMISE (PROspective Multicenter Imaging Study for Evaluation of chest pain) represent the 2 largest and most comprehensive cardiovascular imaging outcome trials in patients with stable chest pain and provide significant insights into patient diagnosis, management, and outcomes. These trials are particularly timely, given the well-recognized knowledge gaps and widespread use of noninvasive imaging. The overall goal of this review is to distill the data generated from these 2 pivotal trials to better inform the practicing clinician in the selection of noninvasive testing for stable chest pain. Similarities and differences between SCOT-HEART and PROMISE are highlighted, and clinical and practical implications are discussed. Both trials show that coronary computed tomography angiography should have a greater role in the diagnostic pathway of patients with stable chest pain.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina. Electronic address: christopher.fordyce@duke.edu.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Fordyce
authors.affiliation: British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, Edinburgh, United Kingdom.
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D057791:Cardiac Imaging Techniques / Q000379:methods*; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D017410:Practice Guidelines as Topic; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: angina pectoris; coronary artery disease; noninvasive cardiac imaging; patient selection