Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease.
Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease.
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DOI：
10.1016/j.jacc.2016.02.026
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发表时间：
2016-04-19
影响因子：
24
通讯作者：
SCOT-HEART Investigators
中科院分区：
文献类型：
--
作者：
Williams MC;Hunter A;Shah ASV;Assi V;Lewis S;Smith J;Berry C;Boon NA;Clark E;Flather M;Forbes J;McLean S;Roditi G;van Beek EJR;Timmis AD;Newby DE;SCOT-HEART Investigators
在一项前瞻性、多中心、随机对照试验中，4146例患者随机接受标准治疗或标准治疗加冠状动脉ct血管造影（CCTA）。本研究的目的是探讨ccta辅助诊断对侵入性冠状动脉造影、预防治疗和临床结果的影响。在事后分析中，我们利用国家电子健康记录评估了侵入性冠状动脉造影、预防性治疗和临床结果的变化。尽管总体发生率相似（409比401；p = 0.451），但侵入性血管造影显示冠状动脉正常的可能性较小(20比56；风险比[hr]: 0.39[95%可信区间（CI）： 0.23至0.68]；p < 0.001)，但更有可能出现阻塞性冠状动脉疾病（283 vs 230；风险比：1.29 [95% CI: 1.08 ~ 1.55]; p = 0.005）。CCTA后开始更多的预防性治疗（283对74；HR: 4.03 [95% CI: 3.12至5.20];p < 0.001），每种药物在就诊后48至52天开始使用。从预防性治疗开始的中位时间（50天）开始，与标准治疗组相比，CCTA组致死性和非致死性心肌梗死减少了一半（17 vs. 34; HR: 0.50 [95% CI: 0.28 ~ 0.88]; p = 0.020）。CCTA组的6个月累积成本略高：差异为462美元（95% CI: 303美元至621美元）。在冠心病引起的疑似心绞痛患者中，CCTA导致更适当地使用侵入性血管造影和改变预防性治疗，可使致死性和非致死性心肌梗死减少一半。（苏格兰心脏计算机断层扫描试验[SCOT-HEART]； NCT01149590）
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). The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. 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). 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)