Cardiac CT Improves Outcomes in Stable Coronary Heart Disease: Results of Recent Clinical Trials

PURPOSE OF REVIEW: The purpose of this study was to review the recent randomised controlled trials of coronary computed tomography angiography (CCTA) for patients with stable coronary artery disease. RECENT FINDINGS: The initial results and subsequent papers from the SCOT-HEART (Scottish COmputed Tomography of the HEART) and PROMISE (PROspective Multicentre Imaging Study for Evaluation of chest pain) trials have shown that CCTA is a safe and appropriate addition to standard care or alternative to functional testing. The SCOT-HEART study showed that CCTA changes diagnoses, improves diagnostic certainty, changes management, leads to more appropriate use of invasive coronary angiography, and reduces fatal and non-fatal myocardial infarction. A meta-analysis of the four randomised controlled trials showed that CCTA leads to a major reduction in myocardial infarction in patients with stable chest pain. SUMMARY: CCTA is now an established technique for the assessment of coronary artery disease. Recent 'test and treat' randomised controlled trials have shown that CCTA guided changes in management can improve clinical outcomes.