title: Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease.
abstract: BACKGROUND
  In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA).
  
  
  OBJECTIVE
  The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes.
  
  
  METHODS
  In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records.
  
  
  RESULTS
  Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621).
  
  
  CONCLUSIONS
  In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Williams
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hunter
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Anoop S V
authors.initials: ASV
authors.lastname: Shah
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Valentina
authors.initials: V
authors.lastname: Assi
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lewis
authors.affiliation: Health Economics Research Centre, University of Oxford, Oxford, United Kingdom.
authors.forename: Joel
authors.initials: J
authors.lastname: Smith
authors.affiliation: Institute for Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Boon
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Clark
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.affiliation: Health Research Institute, University of Limerick, Limerick, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Forbes
authors.affiliation: National Health Service, Fife, United Kingdom.
authors.forename: Scott
authors.initials: S
authors.lastname: McLean
authors.affiliation: Institute for Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Giles
authors.initials: G
authors.lastname: Roditi
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Edwin J R
authors.initials: EJR
authors.lastname: van Beek
authors.affiliation: William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Timmis
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom. Electronic address: d.e.newby@ed.ac.uk.
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
mesh_terms: D000368:Aged; D000066491:Clinical Decision-Making; D057186:Comparative Effectiveness Research; D017023:Coronary Angiography / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D010043:Outcome and Process Assessment, Health Care; D055502:Secondary Prevention / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data
keywords: angina pectoris; invasive coronary angiography; myocardial infarction; preventive therapy