CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial

David Newby; Michelle Williams; Amanda Hunter; Tania Pawade; Anoop Shah; Andrew Flapan; John Forbes; Allister Hargreaves; Stephen Leslie; Steff Lewis; Graham McKillop; Scott McLean; John Reid; James Spratt; Neal Uren; Adam Timmis; Colin Berry; Nicholas Boon; Liz Clark; Peter Craig; Tom Barlow; Marcus Flather; Chiara McCormack; Giles Roditi; Edwin van Beek; Susan Shepherd; Marise Bucukoglu; Valentina Assi; Richard Parker; Ashma Krishan; Fiona Wee; Anthony Wackett; Allan Walker; Lynsey Milne; Kat Oatey; Paul Neary; Gillian Donaldson; Terry Fairbairn; Marlene Fotheringham; Stephen Glen; Sarah Perkins; Fiona Taylor; Louisa Cram; Catherine Beveridge; Avril Cairns; Frances Dougherty; Hany Eteiba; Alan Rae; Kate Robb; Wenda Crawford; Patricia Clarkin; Elisabeth Lennon; Graeme Houston; Stuart Pringle; Prasad Guntur Ramkumar; Thiru Sudarshan; Yvonne Fogarty; Dawn Barrie; Kim Bissett; Adelle Dawson; Scott Dundas; Deborah Letham; Linda O'Neill; Valerie Ritchie; Jonathan Weir-McCall; Hamish Dougall; Faheem Ahmed; Alistair Cormack; Iain Findlay; Stuart Hood; Clare Murphy; Eileen Peat; Lynne McCabe; Margaret McCubbin; Barbara Allen; Miles Behan; Danielle Bertram; David Brian; Amy Cowan; Nicholas Cruden; Martin Denvir; Marc Dweck; Laura Flint; Samantha Fyfe; Neil Grubb; Collette Keanie; Chris Lang; Tom MacGillivray; David MacLachlan; Margaret MacLeod; Saeed Mirsadraee; Avril Morrison; Nicholas Mills; David Northridge; Alyson Phillips; Laura Queripel; Nicholas Weir; Ashok Jacob; Fiona Bett; Frances Divers; Katie Fairley; Edith Keegan; Tricia White; Julia Fowler; John Gemmill; James McGowan; Margo Henry; Mark Francis; Dennis Sandeman; Lorraine Dinnel; Peter Bloomfield; Peter Henriksen; Donald MacLeod; Kenneth Mangion; Ify Mordi; Nikolaos Tzemos; Eugene Connolly; Heather Boylan; Ammani Brown; Lesley Farrell; Alison Frood; Caroline Glover; Janet Johnstone; Kirsten Lanaghan; Deborah McGlynn; Lorraine McGregor; Evonne McLennan; Laura Murdoch; Victoria Paterson; Fiona Teyhan; Marion Teenan; Rosie Woodward; Tracey Steedman; SCOT-HEART Investigators

doi:10.1016/S0140-6736(15)60291-4

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CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial

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CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial

David Newby, Michelle Williams, Amanda Hunter, Tania Pawade, Anoop Shah, Andrew Flapan, John Forbes, Allister Hargreaves, Stephen Leslie, Steff Lewis, …

The Lancet (British edition), Vol.385(9985), pp.2383-2391

13/06/2015

DOI: https://doi.org/10.1016/S0140-6736(15)60291-4

PMID: 25788230

Abstract

General & Internal Medicine

Life Sciences & Biomedicine

Medicine, General & Internal

Science & Technology

Background The benefit of CT coronary angiography (CTCA) in patients presenting with stable chest pain has not been systematically studied. We aimed to assess the effect of CTCA on the diagnosis, management, and outcome of patients referred to the cardiology clinic with suspected angina due to coronary heart disease. Methods In this prospective open-label, parallel-group, multicentre trial, we recruited patients aged 18-75 years referred for the assessment of suspected angina due to coronary heart disease from 12 cardiology chest pain clinics across Scotland. We randomly assigned (1:1) participants to standard care plus CTCA or standard care alone. Randomisation was done with a web-based service to ensure allocation concealment. The primary endpoint was certainty of the diagnosis of angina secondary to coronary heart disease at 6 weeks. All analyses were intention to treat, and patients were analysed in the group they were allocated to, irrespective of compliance with scanning. This study is registered with ClinicalTrials.gov, number NCT01149590. Findings Between Nov 18, 2010, and Sept 24, 2014, we randomly assigned 4146 (42%) of 9849 patients who had been referred for assessment of suspected angina due to coronary heart disease. 47% of participants had a baseline clinic diagnosis of coronary heart disease and 36% had angina due to coronary heart disease. At 6 weeks, CTCA reclassified the diagnosis of coronary heart disease in 558 (27%) patients and the diagnosis of angina due to coronary heart disease in 481 (23%) patients (standard care 22 [1%] and 23 [1%]; p<0.0001). Although both the certainty (relative risk [RR] 2.56, 95% CI 2.33-2.79; p<0.0001) and frequency of coronary heart disease increased (1.09, 1.02-1.17; p=0.0172), the certainty increased (1.79, 1.62-1.96; p<0.0001) and frequency seemed to decrease (0.93, 0.85-1.02; p=0.1289) for the diagnosis of angina due to coronary heart disease. This changed planned investigations (15% vs 1%; p<0.0001) and treatments (23% vs 5%; p<0.0001) but did not affect 6-week symptom severity or subsequent admittances to hospital for chest pain. After 1.7 years, CTCA was associated with a 38% reduction in fatal and non-fatal myocardial infarction (26 vs 42, HR 0.62, 95% CI 0.38-1.01; p=0.0527), but this was not significant. Interpretation In patients with suspected angina due to coronary heart disease, CTCA clarifies the diagnosis, enables targeting of interventions, and might reduce the future risk of myocardial infarction. Copyright (C) Newby et al. Open Access article distributed under the terms of CC BY.

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Title: CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial
Creators - without role: David Newby - Trial Steering Comm, London, England
Michelle Williams
Amanda Hunter
Tania Pawade
Anoop Shah
Andrew Flapan
John Forbes
Allister Hargreaves
Stephen Leslie
Steff Lewis - Trial Steering Comm, London, England
Graham McKillop
Scott McLean
John Reid
James Spratt
Neal Uren
Adam Timmis - Trial Steering Comm, London, England
Colin Berry - Trial Steering Comm, London, England
Nicholas Boon - Trial Steering Comm, London, England
Liz Clark - Trial Steering Comm, London, England
Peter Craig - Trial Steering Comm, London, England
Tom Barlow - Trial Steering Comm, London, England
Marcus Flather - Trial Steering Comm, London, England
John Forbes - Trial Steering Comm, London, England
Chiara McCormack - Trial Steering Comm, London, England
Scott McLean - Trial Steering Comm, London, England
Giles Roditi - Trial Steering Comm, London, England
Edwin van Beek - Trial Steering Comm, London, England
Michelle Williams - Trial Steering Comm, London, England
Amanda Hunter - Trial Steering Comm, London, England
Susan Shepherd - Trial Steering Comm, London, England
Marise Bucukoglu - Trial Steering Comm, London, England
Valentina Assi - Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland
Richard Parker - Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland
Ashma Krishan - Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland
Chiara McCormack - Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland
Fiona Wee - Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland
Anthony Wackett - Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland
Allan Walker - Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland
Lynsey Milne - Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland
Kat Oatey - Edinburgh Clin Trials Unit, Edinburgh, Midlothian, Scotland
Paul Neary - Borders Gen Hosp, Melrose, Scotland
Gillian Donaldson - Borders Gen Hosp, Melrose, Scotland
Terry Fairbairn - Borders Gen Hosp, Melrose, Scotland
Marlene Fotheringham - Borders Gen Hosp, Melrose, Scotland
Allister Hargreaves - Forth Valley Royal Hosp, Larbert, England
James Spratt - Forth Valley Royal Hosp, Larbert, England
Stephen Glen - Forth Valley Royal Hosp, Larbert, England
Sarah Perkins - Forth Valley Royal Hosp, Larbert, England
Fiona Taylor - Forth Valley Royal Hosp, Larbert, England
Louisa Cram - Forth Valley Royal Hosp, Larbert, England
Catherine Beveridge - Forth Valley Royal Hosp, Larbert, England
Avril Cairns - Forth Valley Royal Hosp, Larbert, England
Frances Dougherty - Forth Valley Royal Hosp, Larbert, England
Hany Eteiba - Glasgow Royal Infirm, Glasgow, Lanark, Scotland
Alan Rae - Glasgow Royal Infirm, Glasgow, Lanark, Scotland
Kate Robb - Glasgow Royal Infirm, Glasgow, Lanark, Scotland
Wenda Crawford - Glasgow Royal Infirm, Glasgow, Lanark, Scotland
Patricia Clarkin - Glasgow Royal Infirm, Glasgow, Lanark, Scotland
Elisabeth Lennon - Glasgow Royal Infirm, Glasgow, Lanark, Scotland
Graeme Houston - Ninewells Hosp, Dundee DD1 9SY, Scotland
Stuart Pringle - Ninewells Hosp, Dundee DD1 9SY, Scotland
Prasad Guntur Ramkumar - Ninewells Hosp, Dundee DD1 9SY, Scotland
Thiru Sudarshan - Ninewells Hosp, Dundee DD1 9SY, Scotland
Yvonne Fogarty - Ninewells Hosp, Dundee DD1 9SY, Scotland
Dawn Barrie - Ninewells Hosp, Dundee DD1 9SY, Scotland
Kim Bissett - Ninewells Hosp, Dundee DD1 9SY, Scotland
Adelle Dawson - Ninewells Hosp, Dundee DD1 9SY, Scotland
Scott Dundas - Ninewells Hosp, Dundee DD1 9SY, Scotland
Deborah Letham - Ninewells Hosp, Dundee DD1 9SY, Scotland
Linda O'Neill - Ninewells Hosp, Dundee DD1 9SY, Scotland
Valerie Ritchie - Ninewells Hosp, Dundee DD1 9SY, Scotland
Jonathan Weir-McCall - Ninewells Hosp, Dundee DD1 9SY, Scotland
Hamish Dougall - Perth Royal Infirm, Perth, Scotland
Faheem Ahmed - Royal Alexandra Hosp, Paisley, Renfrew, Scotland
Alistair Cormack - Royal Alexandra Hosp, Paisley, Renfrew, Scotland
Iain Findlay - Royal Alexandra Hosp, Paisley, Renfrew, Scotland
Stuart Hood - Royal Alexandra Hosp, Paisley, Renfrew, Scotland
Clare Murphy - Royal Alexandra Hosp, Paisley, Renfrew, Scotland
Eileen Peat - Royal Alexandra Hosp, Paisley, Renfrew, Scotland
Lynne McCabe - Royal Alexandra Hosp, Paisley, Renfrew, Scotland
Margaret McCubbin - Royal Alexandra Hosp, Paisley, Renfrew, Scotland
Barbara Allen - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Miles Behan - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Danielle Bertram - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
David Brian - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Amy Cowan - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Nicholas Cruden - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Martin Denvir - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Marc Dweck - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Laura Flint - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Andrew Flapan - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Samantha Fyfe - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Neil Grubb - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Collette Keanie - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Chris Lang - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Tom MacGillivray - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
David MacLachlan - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Margaret MacLeod - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Saeed Mirsadraee - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Avril Morrison - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Nicholas Mills - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
David Northridge - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Alyson Phillips - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Laura Queripel - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
John Reid - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Neal Uren - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Nicholas Weir - Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Ashok Jacob - St Johns Hosp, Livingston, Scotland
Fiona Bett - St Johns Hosp, Livingston, Scotland
Frances Divers - St Johns Hosp, Livingston, Scotland
Katie Fairley - St Johns Hosp, Livingston, Scotland
Edith Keegan - St Johns Hosp, Livingston, Scotland
Tricia White - St Johns Hosp, Livingston, Scotland
Julia Fowler - St Johns Hosp, Livingston, Scotland
John Gemmill - AYR
James McGowan - AYR
Margo Henry - AYR
Mark Francis - Victoria Hosp, Kirkcaldy, Scotland
Dennis Sandeman - Victoria Hosp, Kirkcaldy, Scotland
Lorraine Dinnel - Victoria Hosp, Kirkcaldy, Scotland
Peter Bloomfield - Western Gen Hosp, Edinburgh EH4 2XU, Midlothian, Scotland
Martin Denvir - Western Gen Hosp, Edinburgh EH4 2XU, Midlothian, Scotland
Peter Henriksen - Western Gen Hosp, Edinburgh EH4 2XU, Midlothian, Scotland
Donald MacLeod - Western Gen Hosp, Edinburgh EH4 2XU, Midlothian, Scotland
Avril Morrison - Western Gen Hosp, Edinburgh EH4 2XU, Midlothian, Scotland
Colin Berry - University of Glasgow
Kenneth Mangion - University of Glasgow
Ify Mordi - University of Glasgow
Giles Roditi - University of Glasgow
Nikolaos Tzemos - University of Glasgow
Eugene Connolly - University of Glasgow
Heather Boylan - University of Glasgow
Ammani Brown - University of Glasgow
Lesley Farrell - University of Glasgow
Alison Frood - University of Glasgow
Caroline Glover - University of Glasgow
Janet Johnstone - University of Glasgow
Kirsten Lanaghan - University of Glasgow
Deborah McGlynn - University of Glasgow
Lorraine McGregor - University of Glasgow
Evonne McLennan - University of Glasgow
Laura Murdoch - University of Glasgow
Victoria Paterson - University of Glasgow
Fiona Teyhan - University of Glasgow
Marion Teenan - University of Glasgow
Rosie Woodward - University of Glasgow
Tracey Steedman - University of Glasgow
SCOT-HEART Investigators
Publication Details: The Lancet (British edition), Vol.385(9985), pp.2383-2391
Publisher: Elsevier
Number of pages: 9
Grant note: National Health Service Research Scotland (NRS) FS/14/78/31020 / British Heart Foundation CZH/4/588 / Chief Scientist Office CZH/4/588 / The Chief Scientist Office of the Scottish Government Health and Social Care Directorates WT103782AIA / Wellcome Trust; European Commission CH/09/002; FS/11/014 / British Heart Foundation Heart Diseases Research Fund Scottish Imaging Network: A Platform of Scientific Excellence (SINAPSE) Edinburgh and Lothian's Health Foundation Trust Barts Cardiovascular Biomedical Research Unit - National Institute for Health Research National Health Service Research Scotland (NRS) through National Health Service Lothian Health Board MR/K006584/1 / Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC); European Commission
Identifiers: 9919666708331
Academic Unit: King Faisal University
Language: English
Resource Type: Journal article