دورية أكاديمية
Relative clinical value of coronary computed tomography and stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis.
| العنوان: | Relative clinical value of coronary computed tomography and stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis. |
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| المؤلفون: | Vamvakidou A; Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK.; The Royal Brompton Hospital, Sydney Street, Chelsea, SW3 6NP, UK.; National Heart and Lung Institute, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK., Danylenko O; Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK.; The Royal Brompton Hospital, Sydney Street, Chelsea, SW3 6NP, UK., Pradhan J; Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK., Kelshiker M; Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK., Jones T; Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK., Whiteside D; Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK., Sethi A; National Heart and Lung Institute, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK.; The Ealing Hospital, Uxbridge Road, Southall, UB1 3HW, UK., Senior R; Department of Cardiology, The Northwick Park Hospital, Watford Rd, Harrow, HA1 3UJ, UK.; The Royal Brompton Hospital, Sydney Street, Chelsea, SW3 6NP, UK.; National Heart and Lung Institute, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2BU, UK. |
| المصدر: | European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2020 Nov 24. Date of Electronic Publication: 2020 Nov 24. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 101573788 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-2412 (Electronic) Linking ISSN: 20472404 NLM ISO Abbreviation: Eur Heart J Cardiovasc Imaging Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Oxford : Oxford University Press |
| مستخلص: | Aims: The European Society of Cardiology recommends coronary computed tomography (CCT) for the assessment of low-risk patients with suspected stable angina. We aimed to assess in a real-life setting the relative clinical value of stress echocardiography (SE)- and CCT-guided management in this population. Methods and Results: Patients with stable chest pain and no prior history of coronary artery disease (CAD) who underwent CCT or SE as the initial investigative strategy were propensity-matched (990 patients each group-age: 59 ± 13.2 years, males: 47.9%) to account for baseline differences in cardiovascular risk factors. Inconclusive tests were 6% vs. 3% (P < 0.005) in CCT vs. SE. Severe (≥70% stenosis) on CCT and inducible ischaemia on SE detected obstructive CAD by invasive coronary angiography in 63% vs. 57% patients (P = 0.33). Over the follow-up period (median 717, interquartile range 93-1069 days) more patients underwent invasive coronary angiography (21.5% vs. 7.3%, P < 0.005), revascularization (7.3% vs. 3.5%, P < 0.005), further functional testing 33.4% vs. 8.7% (P < 0.005), but more patients were prescribed statins 8.8% vs. 3.8% (P < 0.005) in the CCT vs. the SE arm, respectively. Combined all-cause mortality and acute myocardial infarction was low-CCT-2.3% and SE-3.3%-with no significant difference (P = 0.16). Conclusion: Initial SE-guided management was similar for the detection of obstructive CAD, demonstrated better resource utilization, but was associated with reduced prescription of statins although with no difference in medium-term outcome compared to CCT in this very low-risk population. However, a randomized study with longer follow-up is needed to confirm the clinical value of our findings. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.) |
| فهرسة مساهمة: | Keywords: coronary angiography; coronary computed tomography; revascularization; stable chest pain; stress echocardiography |
| تواريخ الأحداث: | Date Created: 20201124 Latest Revision: 20240222 |
| رمز التحديث: | 20240223 |
| DOI: | 10.1093/ehjci/jeaa303 |
| PMID: | 33232454 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2047-2412 |
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| DOI: | 10.1093/ehjci/jeaa303 |