CT Angiography Helpful in Suspected Stable Angina, but Not N
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Recent European guidance supports a diminished role for exercise electrocardiography (ECG) in the assessment of suspected stable angina.

This study aimed evaluate the utility of exercise ECG in contemporary practice and assess the value of combined functional and anatomical testing.

In a post hoc analysis of the Scottish Computed Tomography of the Heart (SCOT-HEART) open-label randomized clinical trial, conducted in 12 cardiology chest pain clinics across Scotland for patients with suspected angina secondary to coronary heart disease. 4146 patients aged 18 to 75 years with stable angina underwent clinical evaluation and 1417 of 1651 underwent exercise ECG prior to randomization. The primary clinical end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years.

- Among the 3283 patients, exercise ECG had a sensitivity of 39% and a specificity of 91% for detecting any obstructive coronary artery disease in those who underwent subsequent invasive angiography.
- Abnormal results of exercise ECG were associated with a 14.47-fold increase in coronary revascularization at 1 year and a 2.57-fold increase in mortality from coronary heart disease death at 5 years or in cases of nonfatal myocardial infarction at 5 years.
- Compared with exercise ECG alone, results of coronary CT angiography had a stronger association with 5-year coronary heart disease death or nonfatal myocardial infarction.
- The greatest numerical difference in outcome with CT angiography compared with exercise ECG alone was observed for those with inconclusive results of exercise ECG, although this was not statistically significant.

Conclusively, this study suggests that abnormal results of exercise ECG are associated with coronary revascularization and the future risk of adverse coronary events. However, coronary CT angiography more accurately detects coronary artery disease and is more strongly associated with future risk compared with exercise ECG.

Source: https://jamanetwork.com/journals/jamacardiology/article-abstract/2766244