Outcomes of anatomical versus functional testing for coronary artery disease

The New England Journal of Medicine
Pamela S DouglasPROMISE Investigators

Abstract

Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic testing, although there are limited data from randomized trials to guide care. We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P=0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than...Continue Reading

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Citations

Feb 20, 2016·Journal of the American College of Cardiology·Christopher B FordycePamela S Douglas
Jun 2, 2015·Expert Review of Pharmacoeconomics & Outcomes Research·Giuseppe TurchettiDanilo Neglia
Apr 29, 2015·Expert Review of Cardiovascular Therapy·Erick Alexanderson-RosasAloha Meave-Gonzalez
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