Background: CT coronary angiography (CTCA) is a relatively new technology that has gained popularity over the past few years in evaluating patients presenting with chest pain. CTCA is an anatomic test that has been shown to increase downstream testing and increase healthcare costs but its impact on patient-oriented benefit has been questioned. Early concerns of CTCA including poor image quality in the obese and high levels of radiation exposure have been mitigated by improved technology.
Another trial, called PROMISE, also evaluated anatomic CCTA vs functional stress testing in greater than 10,000 patients with symptomatic chest pain with suspected CAD. In this study an initial strategy of CCTA was not associated with better clinical outcomes compared to functional testing over a median follow-up period of two years, and it was also associated with higher radiation exposure and downstream testing.
In this post we will cover the original SCOT-HEART trial published in 2015  and the 5 year follow up of the original SCOT-HEART trial . Read more →