A large clinical trial comparing computed-tomography angiography with functional testing found no benefit to clinical outcomes with CTA, which also exposes patients to large doses of radiation.
Results of the randomized 10,000-patient Promise trial, presented at the American College of Cardiology’s annual meeting, showed that the primary endpoint of a composite of death, myocardial infarction, hospitalization for unstable angina or major procedural complications was no better for CTA than functional testing after 2 years.
The study, published in the New England Journal of Medicine, found that a primary endpoint event occurred in 3.3% of patients in the angiography group, compared with 3.0% of the functional testing control group. In the CTA cohort, 12.2% of patients had at least 1 cardiac catheterization, versus 8.1% for the control group. Among patients who underwent catheterization, 27.9% were found to have no obstructive disease, compared with 52.5% of the control group.
"These findings highlight a substantial opportunity to improve the selection of patients for noninvasive testing beyond currently accepted approaches," the authors wrote. The study was funded by the National Heart, Lung & Blood Institute.
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