A CT-first strategy in patients with suspected angina pectoris was associated with significantly lower all-cause mortality compared to usual care (1.9% vs 3.5%; HR 0.51; 95% CI 0.37 to 0.70).
Cohort (n=12,545)
Yes
Does a CT-first strategy reduce mortality in patients presenting with a first episode of suspected angina pectoris?
A CT-first strategy for patients with suspected angina pectoris is associated with increased use of preventive therapies and significantly lower all-cause mortality compared to usual care.
Effect estimate: HR 0.51 (95% CI 0.37 to 0.70)
Absolute Event Rate: 1.9% vs 3.5%
OBJECTIVES: To investigate the impact of a CT-first strategy on all-cause and cardiovascular mortality in patients presenting with chest pain in outpatient cardiology clinics. METHODS: Patients with a first presentation of suspected angina pectoris were identified and their data linked to the registrations of Statistics Netherlands for information on mortality. The linked database consisted of 33 068 patients. CT-first patients were defined as patients with a CT calcium score and coronary CT angiography, within 6 weeks after their initial visit. Propensity score matching (1:5) was used to match patients with and without a CT-first strategy. After matching, 12 545 patients were included of which 2308 CT-first patients and 10 237 patients that underwent usual care. RESULTS: Mean age was 57 years, 56.3% were women and median follow-up was 4.9 years. All-cause mortality was significantly lower in CT-first patients (n=43, 1.9%) compared with patients without CT (n=363, 3.5%) (HR: 0.51, 95% CI 0.37 to 0.70). Furthermore, CT-first patients were more likely to receive cardiovascular preventative and antianginal medication (aspirin: 44.9% vs 27.1%, statins: 48.7% vs 30.3%, beta-blockers: 37.8% vs 25.5%, in CT-first and without CT-first patients, respectively) and to undergo downstream diagnostics and interventions (coronary interventions: 8.5% vs 5.7%, coronary angiography: 16.2% vs 10.6% in CT-first and without CT-first patients, respectively). CONCLUSIONS: In a real-world regular care database, a CT-first strategy in patients suspected of angina pectoris was associated with a lowering of all-cause mortality.
Siegersma et al. (Mon,) conducted a cohort in suspected angina pectoris (n=12,545). CT-first strategy vs. usual care was evaluated on all-cause mortality (HR 0.51, 95% CI 0.37 to 0.70). A CT-first strategy in patients with suspected angina pectoris was associated with significantly lower all-cause mortality compared to usual care (1.9% vs 3.5%; HR 0.51; 95% CI 0.37 to 0.70).