Name:
CTA Study Points at Benefits of Wider Use
Description:
CTA Study Points at Benefits of Wider Use
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T00H04M46S
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's, The Heart Board Review, and other online resources available only through accesscardiology.com. >> Is CTA underutilized in coronary artery disease? Several clinical trials recently are highlighting the importance of CTA in assessing patients with moderate to severe ischemia. That leaves us with a question. Should we lower our threshold for referring patients for CTA?
Dr. Bernie here, and welcome to Practice Impact Extra. As cardiologists, we see so many people with stable chest pain, and we know this is a frequent complaint that's often suggestive of coronary heart disease. Now, we evaluate patients by a variety of noninvasive stress tests that include radionuclide scintigraphy, echo, and MRI. These techniques are useful in assisting with the diagnosis of coronary artery disease, as well as providing very important prognostic information.
What about CTA, coronary computerized tomography? It certainly helps clarify the diagnosis and can oftentimes lead to modification of treatments for patients with stable chest pain. There was a study that was published 2 years ago, SCOT-HEART. It was a study from Scotland that initially was reviewed and then had a post hoc analysis suggesting that the use of CTA altered treatments and actually resulted in better clinical outcomes than standard care alone.
That study was for approximately 20 months. At the most recent 2018 European Society of Cardiology meetings, the 5-year data on SCOT-HEART was reported by the researchers to look and determine whether the effect of CTA continued on long -- continued to have the positive effects on a longer period of time and follow-up for 5 years. Initially, the study had enrolled 4,146, so over 4,000 patients, with stable chest pain.
They were referred to one of 12 cardiology clinics in Scotland. Patients were evaluated, physical, history, and blood tests, and had a risk assessment assigned. They then had some testing. And then, following that, they were randomized to either undergo CTA plus standard care of therapy or just be assigned to a standard care therapy, and followed at those clinics. The primary endpoint is death from coronary heart disease or non-fatal MI at the fifth year or during that 5-year period.
The 5-year clinical outcomes noted the use of CTA had a significant ability to better define whether or not underlying atherosclerosis exists. And significantly, it was associated with a lower death rate and a lower rate of non-fatal myocardial infarction than standard care alone. The primary endpoint in the CTA group was 2.3% versus those who just received standard care at 3.9%. A lot of thought was given and really reassessed was that because more patients in that 5 years were referred for invasive evaluation and revascularization and that may have changed the outcomes?
Well, looking back over the past 5 years with the SCOT-HEART trial, that was not the case. And actually, invasive evaluation and revascularization were similar for both groups at 5 years. Is there a take-home message here? And certainly, there is. I believe the use of CTA resulted in more correct diagnosis of coronary artery disease than standard care alone. This in turn led to the use of more appropriate therapies, and this change in management resulted in fewer clinical events in the CTA group compared to the standard group.
Again, as I mentioned, this was without the greater long-term use of invasive coronary angiography or coronary revascularization. So, thanks again for joining me on Practice Impact Extra, and see you next time. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features.
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