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Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE.

Publication ,  Journal Article
Bittner, DO; Ferencik, M; Douglas, PS; Hoffmann, U
Published in: Curr Cardiol Rep
May 2016

The PROMISE (Prospective multicenter imaging study for evaluation of chest pain) trial compared the effectiveness of coronary CT angiography and functional testing as initial diagnostic test for patients with suspicion for stable coronary artery disease (CAD). With 10,003 patients randomized at 193 sites, the PROMISE trial provides a snapshot of real-world care for this very common presentation. Over a median follow-up of 25 months, PROMISE did not find significant differences in major clinical events (composite endpoint 164 vs. 151, HR 1.04 (0.83-1.29); p = 0.75) between the two strategies. Other major findings were the large discrepancy between estimates of pre-test likelihood and observed prevalence for obstructive CAD (≥50 %) and the proportion of noninvasive tests positive for ischemia or obstructive CAD (53 vs. 11 %; respectively) and the better efficiency of coronary computed tomography angiography (CTA) to select patients for invasive coronary angiography (ICA) who had obstructive CAD (72 vs. 48 % for coronary CTA and functional testing, respectively). Radiation exposure was higher in the CT arm compared to all functional testing but lower than for nuclear perfusion stress testing. Improvement of patient selection for diagnostic testing and risk stratification will be keys to increase efficacy and efficiency of management of patients with suspicion for stable CAD.

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Published In

Curr Cardiol Rep

DOI

EISSN

1534-3170

Publication Date

May 2016

Volume

18

Issue

5

Start / End Page

40

Location

United States

Related Subject Headings

  • Prospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Female
  • Coronary Artery Disease
  • Computed Tomography Angiography
  • Chest Pain
  • Cardiovascular System & Hematology
 

Citation

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Bittner, D. O., Ferencik, M., Douglas, P. S., & Hoffmann, U. (2016). Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE. Curr Cardiol Rep, 18(5), 40. https://doi.org/10.1007/s11886-016-0718-9
Bittner, Daniel O., Maros Ferencik, Pamela S. Douglas, and Udo Hoffmann. “Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE.Curr Cardiol Rep 18, no. 5 (May 2016): 40. https://doi.org/10.1007/s11886-016-0718-9.
Bittner, Daniel O., et al. “Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE.Curr Cardiol Rep, vol. 18, no. 5, May 2016, p. 40. Pubmed, doi:10.1007/s11886-016-0718-9.
Journal cover image

Published In

Curr Cardiol Rep

DOI

EISSN

1534-3170

Publication Date

May 2016

Volume

18

Issue

5

Start / End Page

40

Location

United States

Related Subject Headings

  • Prospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Female
  • Coronary Artery Disease
  • Computed Tomography Angiography
  • Chest Pain
  • Cardiovascular System & Hematology