Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland
Key result
CCTA-guided management of stable chest pain reduced coronary heart disease death or non-fatal myocardial infarction compared with standard care alone (6.6% vs 8.2%; HR 0.79; 95% CI 0.63-0.99; p=0.044).
Why the study?
Although coronary CT angiography (CCTA)-guided management was shown to improve diagnosis, management, and outcomes in stable chest pain, whether these improvements are sustained long-term remained unclear.
Does standard of care plus coronary CT angiography reduce coronary heart disease death or non-fatal myocardial infarction in patients with suspected stable angina?
Population
4146 patients aged 18-75 years with suspected stable angina due to coronary heart disease
Comparison
Standard of care plus CCTA vs standard of care alone
Design
Open-label multicentre parallel-group randomised controlled trial
Follow-up
Median 10·0 years
Authors
Discussion
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Member takes
Implication
Supports CCTA-guided care for stable chest pain; extends short-term benefits to sustained 10-year outcomes.
Study Design
Type
RCT (n=4,146)
Blinding
Open-label
Randomization
1:1
Multicenter
Yes
Structured PICO
Does standard of care plus coronary CT angiography reduce coronary heart disease death or non-fatal myocardial infarction in patients with suspected stable angina?
P
Population
4,146 patients aged 18-75 years with suspected stable angina due to coronary heart disease, followed for a median of 10.0 years.
I
Intervention
Standard of care plus coronary CT angiography (CCTA)
C
Comparator
Standard of care alone
O
Outcome
Composite of coronary heart disease death or non-fatal myocardial infarction on an intention-to-treat basis at median 10.0 years follow-upcomposite
Main Result
Hazard Ratio: 0.79 (95% CI 0.63–0.99)
Absolute Event Rate: 6.6% vs 8.2%
p-value: p=0.044
In patients with suspected stable angina, CCTA-guided management provides a sustained reduction in coronary heart disease death or non-fatal myocardial infarction over 10 years, likely driven by improved preventive therapy prescribing.
Cite This Study
Williams et al. (2025) conducted an RCT in Suspected stable angina due to coronary heart disease (n=4,146). Coronary CT angiography (CCTA) plus standard of care vs. Standard of care alone was evaluated on Coronary heart disease death or non-fatal myocardial infarction (HR 0.79, 95% CI 0.63-0.99, p=0.044). CCTA-guided management of stable chest pain reduced coronary heart disease death or non-fatal myocardial infarction compared with standard care alone (6.6% vs 8.2%; HR 0.79; 95% CI 0.63-0.99; p=0.044).