Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyApril 2025
Computed tomographic angiography-guided management lowered incidence of myocardial infarction and death, but invasive angiography rates were similar.
More than a decade ago, investigators enrolled 4100 patients with suspected stable angina (mean age, 57 years) at 12 Scottish clinics in the SCOT-HEART trial (NEJM JW Gen Med 1 May 2015 and Lancet 2015; 385: 2383-2391) and randomised them to receive standard care (at that time, mostly symptom-limited exercise electrocardiography) or standard care plus computed tomographic angiography (CTA). Short-term results suggested that CTA guided management improved diagnosis, management and outcomes.
Now, after a median 10 years of follow up, the researchers report that coronary heart disease-related death or nonfatal myocardial infarction (MI) was less common in the CTA-guided group than in the standardcare group (6.6% vs 8.2%), mostly due to fewer MIs (4.3% vs 6.0%). Overall mortality was similar. Invasive angiography and coronary revascularisation rates were similar, but prescribing of ‘preventive medical therapy’ (i.e. antiplatelet or statin therapy) was more frequent in the CTA group (55.9% vs 49.0%).
Comment: These data suggest that the benefits of CTA-guided therapy were sustained during 10 years in association with higher rates of medical therapy, although overall prescribing rates remained relatively low for a cohort with stable angina. Although an editorialist notes that contemporary standard care probably is different (both groups initially were evaluated with exercise electrocardiography), the results do support the growing use of CTA to evaluate patients with suspected stable angina.
Kirsten E. Fleischmann, MD, MPH, FACC, Professor of Clinical Medicine and Assistant Chair of Medicine, Faculty Experience, University of California San Francisco School of Medicine, San Francisco, USA.
Williams MC, et al. Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland. Lancet 2025; 405: 329-337.
Villines TC. Durability of patient benefit from CT-guided chest pain management. Lancet 2025; 405: 278-279.
This summary is taken from the following Journal Watch titles: General Medicine, Cardiology, Ambulatory Medicine.