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Management of coronary artery disease with cardiac CT beyond gatekeeping
  1. Filippo Cademartiri1,2,
  2. Stefano Nistri3,
  3. Giuseppe Tarantini4,
  4. Erica Maffei1
  1. 1Department of Radiology & Research Center, Montreal Heart Institute/Universitè de Montreal, Montreal, Quebec, Canada
  2. 2Department of Radiology, Erasmus Medical Center University, Rotterdam, The Netherlands
  3. 3Cardiology Service, CMSR- Veneto Medica, Altavilla Vicentina, Italy
  4. 4Department of Cardiology, University of Padua, Padua, Italy
  1. Correspondence to Professor Filippo Cademartiri, Department of Radiology, Montreal Heart Institute,Centre de Recherche, room S-2530, 5000 Rue Belanger, Montreal, Quebec, Canada H1T 1C8; filippocademartiri{at}

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This journal reports an analysis of symptoms and quality of life (QOL) of patients enrolled in the Scottish COmputed Tomography of the HEART (SCOT-HEART).1

Last year the results of the two major trials on cardiovascular imaging strategies for the diagnosis of coronary artery disease (CAD) were published (ie, PROMISE/PROspective Multicenter Imaging Study for Evaluation of chest pain—performed in North America and SCOT-HEART—performed in Scotland).2–4 They were structured to analyse the impact of cardiac CT (CCT) on current standards of care.

The PROMISE trial ultimately showed a diagnostic and prognostic equivalence of anatomical strategy versus the North American standard of care; although more patients in the CCT group underwent cardiac catheterisation within 3 months after randomisation, the secondary end point of the frequency of catheterisation showing no obstructive CAD was significantly lower in the CCT group.

The SCOT-HEART investigated the incremental value of CCT on top of a European standard of care. The end point was certainty of the diagnosis of angina secondary to coronary heart disease at 6 weeks, while long-term outcomes were major adverse cardiovascular events. Most patients underwent stress ECG (85%) and a third underwent other stress imaging tests. CCT improved diagnosis, treatment and outcome of symptomatic stable patients with suspected CAD. The improvement was associated with better selection of patients for invasive coronary angiography, more appropriate changes in therapy, and a halving in the rates of fatal and …

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