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Randomized Controlled Trial
. 2014 Jun;167(6):796-803.e1.
doi: 10.1016/j.ahj.2014.03.003. Epub 2014 Mar 18.

PROspective Multicenter Imaging Study for Evaluation of chest pain: rationale and design of the PROMISE trial

Pamela S Douglas  1 , Udo Hoffmann  2 , Kerry L Lee  3 , Daniel B Mark  3 , Hussein R Al-Khalidi  3 , Kevin Anstrom  3 , Rowena J Dolor  3 , Andrzej Kosinski  3 , Mitchell W Krucoff  3 , Daniel W Mudrick  4 , Manesh R Patel  3 , Michael H Picard  2 , James E Udelson  5 , Eric J Velazquez  3 , Lawton Cooper  6 ; PROMISE investigators
Collaborators, Affiliations
Randomized Controlled Trial

PROspective Multicenter Imaging Study for Evaluation of chest pain: rationale and design of the PROMISE trial

Pamela S Douglas et al. Am Heart J. 2014 Jun.

Abstract

Background: Suspected coronary artery disease (CAD) is one of the most common, potentially life-threatening diagnostic problems clinicians encounter. However, no large outcome-based randomized trials have been performed to guide the selection of diagnostic strategies for these patients.

Methods: The PROMISE study is a prospective, randomized trial comparing the effectiveness of 2 initial diagnostic strategies in patients with symptoms suspicious for CAD. Patients are randomized to either (1) functional testing (exercise electrocardiogram, stress nuclear imaging, or stress echocardiogram) or (2) anatomical testing with ≥64-slice multidetector coronary computed tomographic angiography. Tests are interpreted locally in real time by subspecialty certified physicians, and all subsequent care decisions are made by the clinical care team. Sites are provided results of central core laboratory quality and completeness assessment. All subjects are followed up for ≥1 year. The primary end point is the time to occurrence of the composite of death, myocardial infarction, major procedural complications (stroke, major bleeding, anaphylaxis, and renal failure), or hospitalization for unstable angina.

Results: More than 10,000 symptomatic subjects were randomized in 3.2 years at 193 US and Canadian cardiology, radiology, primary care, urgent care, and anesthesiology sites.

Conclusion: Multispecialty community practice enrollment into a large pragmatic trial of diagnostic testing strategies is both feasible and efficient. The PROMISE trial will compare the clinical effectiveness of an initial strategy of functional testing against an initial strategy of anatomical testing in symptomatic patients with suspected CAD. Quality of life, resource use, cost-effectiveness, and radiation exposure will be assessed.

Trial registration: ClinicalTrials.gov NCT01174550.

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Figures

Figure 1
Figure 1. Overall Study Design
CAD = Coronary artery disease; Ex ECG = Exercise ECG; Stress echo = Stress echocardiography; MPI= Myocardial perfusion imaging; Dx = Diagnostic.
See this image and copyright information in PMC

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