1. Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain
- Author
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Hoffmann, Udo, Ferencik, Maros, Udelson, James E, Picard, Michael H, Truong, Quynh A, Patel, Manesh R, Huang, Megan, Pencina, Michael, Mark, Daniel B, Heitner, John F, Fordyce, Christopher B, Pellikka, Patricia A, Tardif, Jean-Claude, Budoff, Matthew, Nahhas, George, Chow, Benjamin, Kosinski, Andrzej S, Lee, Kerry L, and Douglas, Pamela S
- Subjects
Clinical Trials and Supportive Activities ,Clinical Research ,Cardiovascular ,Atherosclerosis ,Biomedical Imaging ,Heart Disease - Coronary Heart Disease ,Pain Research ,Heart Disease ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Aged ,Chest Pain ,Coronary Angiography ,Coronary Artery Disease ,Echocardiography ,Stress ,Exercise Test ,Female ,Follow-Up Studies ,Humans ,Male ,Middle Aged ,Prognosis ,Prospective Studies ,Tomography ,X-Ray Computed ,coronary artery disease ,diagnostic tests ,routine ,prognosis ,PROMISE Investigators ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology - Abstract
BackgroundOptimal management of patients with stable chest pain relies on the prognostic information provided by noninvasive cardiovascular testing, but there are limited data from randomized trials comparing anatomic with functional testing.MethodsIn the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), patients with stable chest pain and intermediate pretest probability for obstructive coronary artery disease (CAD) were randomly assigned to functional testing (exercise electrocardiography, nuclear stress, or stress echocardiography) or coronary computed tomography angiography (CTA). Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. The primary end point was death, myocardial infarction, or unstable angina hospitalizations over a median follow-up of 26.1 months.ResultsBoth the prevalence of normal test results and incidence rate of events in these patients were significantly lower among 4500 patients randomly assigned to CTA in comparison with 4602 patients randomly assigned to functional testing (33.4% versus 78.0%, and 0.9% versus 2.1%, respectively; both P10%) who had a normal functional test were reclassified as being mildly abnormal, the discriminatory capacity improved to 0.69 (95% CI, 0.64-0.74).ConclusionsCoronary CTA, by identifying patients at risk because of nonobstructive CAD, provides better prognostic information than functional testing in contemporary patients who have stable chest pain with a low burden of obstructive CAD, myocardial ischemia, and events.Clinical trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01174550.
- Published
- 2017