Thursday, May 4, 2017

Prognostic Value of CCTA in Stable Chest Pain: Insights from PROMISE

Published in Circulation

This paper (Hoffmann et al. Circulation 2017) provides generalizable data for one of the fundamental elements of cardiology patient care establishing that hallmarks of traditional stable chest pain assessment such as obstructive CAD and myocardial ischemia have comparable prognostic value. However, as other studies have shown, statins and improved cardiovascular risk management have lowered the clinical event risk of these patients as compared to 30 years ago. In this changed situation, we clearly show the benefit of CTA being able to detect subclinical atherosclerotic disease, i.e. non-obstructive CAD to identify an additional at risk population, in which a large proportion of future clinical events occur. These data will enable caregivers to make an objective data driven choice as to which diagnostic test may be most beneficial for a patient presenting with stable chest pain.

Two additional papers from our group highlight potential uses of CCTA:

  • Emami et al. JACC Imaging 2017 demonstrates how information on non-obstructive CAD can be used in clinical practice to recalibrate the ASCVD Risk Score and to revise statin eligibility.
  • Lu et al. JACC Imaging 2017 assessed the potential for noninvasive fractional flow reserve derived from coronary CT angiography (FFRCT) to improve efficiency of referral to invasive coronary angiography in the PROMISE trial.

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