News | Computed Tomography (CT) | April 26, 2016

CT-Guided Therapeutic Decision-Making Enables Reduction in Myocardial Infarction

New SCOT-HEART substudy shows coronary CT angiography cut MI risk in half compared to usual care

coronary CT angiography, CCTA, SCOT-HEART trial substudy, SCCT

April 26, 2016 — The results of a secondary analysis of the SCOT-HEART trial show that coronary computed tomography angiography (CCTA) leads to a more appropriate and effective selection of invasive coronary angiography for patients with suspected angina due to coronary heart disease. The use of CCTA also contributed to greater use of preventive therapies that led to a 50 percent reduction in risk for fatal and non-fatal myocardial infarction when compared to usual care, largely including stress testing.

The SCOT-HEART (Scottish COmputed Tomography of the HEART) trial demonstrated that CCTA markedly clarified the diagnosis for patients with suspected angina due to coronary heart disease. However, whether the CCTA-guided changes in diagnosis led to appropriate improvements in invasive coronary angiography and initiation of preventive treatments, and whether these changes could be attributable to an improvement in clinical outcome, had not been explored.

"SCOT-HEART has shown for the first time that CT coronary angiography can be used to reduce mortality in patients with suspected coronary heart disease. We showed that computed tomography improved the certainty of diagnosis, changed the prescription of preventative therapies and led to more appropriate use of invasive coronary angiography," said lead author Michelle C. Williams, M.D., MBChB, of the British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, U.K. "This resulted in the halving of fatal and non-fatal myocardial infarction after these changes in management were implemented. With SCOT-HEART we have moved beyond studies of diagnostic accuracy, and this study will certainly change practice."

"With this seminal analysis, CCTA has moved from a diagnostic test with unparalleled accuracy and significant prognostic information, to a test that can effectively guide therapeutic decision making," said Society of Cardiovascular Computed Tomography (SCCT) President Jonathon Leipsic, M.D., FSCCT. "The ability to help guide treatment strategies that reduce hard events will inevitably disrupt traditional care pathways."

Commenting on this study, SCCT President-Elect Leslee Shaw, Ph.D., FSCCT noted that "new findings conclusively demonstrate that CCTA is by far one of the key components to guide accurate diagnosis of and effective treatment for coronary artery disease (CAD). These findings will provide a new approach to diagnosis and treatment of CAD. Although requiring future validation, this analysis suggests that optimal improvements in patient outcomes can best be facilitated by CCTA."

The potential implications of this study on patient management following CTA are profound, according to Todd Villines, M.D., FSCCT, chair of the SCCT Education Committee. He noted that "the identification of both non-obstructive and obstructive (potentially flow-limiting) coronary artery disease is a tremendous advantage of coronary CTA. These findings demonstrate that disease burden on CTA, including non-obstructive disease, leads to important therapeutic changes that significantly reduce a patient's risk of suffering a first heart attack."

In an accompanying editorial, SCCT Past President James K. Min, M.D., FSCCT, professor of radiology at Weill Cornell Medical College and director of the Dalio Institute of Cardiovascular Imaging at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, spoke to the implications of these results. "This secondary analysis of SCOT-HEART is the highest-quality evidence to date for the comparative benefit of CCTA over standard-of-care approaches...In aggregate, these studies suggest that not only may CCTA be considered a reasonable alternative to stress testing for initial diagnostic CAD evaluation, but it may actually be preferred," he said.

For more information: www.scct.org

Related Content

New Best Practices Help Manage Heart Attack Patients Without Significant Signs
News | Cardiac Diagnostics | April 15, 2019
For the first time in the United States, doctors with the American Heart Association (AHA) have outlined best practices...
The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes.

The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes. 

Feature | Cardiac Diagnostics | March 22, 2019 | Linda C. Rogers, Ph.D.
Troponins are a family of proteins found in skeletal and heart (cardiac) muscle fibers that produce muscular contract
ACC/AHA Update Guidance for Preventing Heart Disease; Stroke
Feature | Cardiac Diagnostics | March 18, 2019
The choices we make every day can have a lasting effect on our heart and vascular health. Adopting a heart healthy...
AHA Statement Warns Hookah Smoking May Harm the Heart
News | Cardiac Diagnostics | March 08, 2019
Smoking tobacco in waterpipes, more commonly known as hookahs, results in inhaling toxic chemicals, often at levels...
PTSD Alone Does Not Increase Heart Disease Risk in Veterans
News | Cardiac Diagnostics | February 20, 2019
February 20, 2019 — Post-traumatic stress disorder (PTSD) by itself does not explain the...
Hormone Therapy May Increase Cardiovascular Risk During Gender Transition
News | Cardiac Diagnostics | February 18, 2019
Patients receiving hormone therapy as part of their gender-transition treatment had an elevated risk for cardiovascular...
IBM and Broad Institute Launch AI Initiative for Cardiovascular Disease Risk Prediction
News | Cardiac Diagnostics | February 15, 2019
IBM Watson Health and the Broad Institute of MIT and Harvard are launching a research partnership aimed at developing...
Nearly Half of All U.S. Adults Have Cardiovascular Disease
News | Cardiac Diagnostics | January 31, 2019
January 31, 2019 — Nearly half (48 percent, 121.5 million in 2016) of all adults in the United States have some type
Frequent Red Meat Consumption Triples Levels of Chemical Associated With Heart Disease
News | Cardiac Diagnostics | January 23, 2019
Researchers have identified another reason to limit red meat consumption: high levels of a gut-generated chemical...
Overlay Init