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Review
. 2016 Feb 23;67(7):843-52.
doi: 10.1016/j.jacc.2015.11.055.

Diagnostic Strategies for the Evaluation of Chest Pain: Clinical Implications From SCOT-HEART and PROMISE

Christopher B Fordyce  1 , David E Newby  2 , Pamela S Douglas  3
Affiliations
Review

Diagnostic Strategies for the Evaluation of Chest Pain: Clinical Implications From SCOT-HEART and PROMISE

Christopher B Fordyce et al. J Am Coll Cardiol. .

Abstract

SCOT-HEART (Scottish COmputed Tomography of the HEART) and PROMISE (PROspective Multicenter Imaging Study for Evaluation of chest pain) represent the 2 largest and most comprehensive cardiovascular imaging outcome trials in patients with stable chest pain and provide significant insights into patient diagnosis, management, and outcomes. These trials are particularly timely, given the well-recognized knowledge gaps and widespread use of noninvasive imaging. The overall goal of this review is to distill the data generated from these 2 pivotal trials to better inform the practicing clinician in the selection of noninvasive testing for stable chest pain. Similarities and differences between SCOT-HEART and PROMISE are highlighted, and clinical and practical implications are discussed. Both trials show that coronary computed tomography angiography should have a greater role in the diagnostic pathway of patients with stable chest pain.

Keywords: angina pectoris; coronary artery disease; noninvasive cardiac imaging; patient selection.

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Figures

Figure 1
Figure 1. Diagnostic Strategies for the Evaluation of Chest Pain
The left-hand column shows the Fryback and Thornbury model for assessing diagnostic test evidence on the basis of hierarchical levels of clinical outcomes (19). These levels range from technical quality and diagnostic/prognostic accuracy to establishing a test's impact on clinical decision-making to societal outcomes. The findings of both trials are summarized in subsequent columns, providing a comparison of the types of evidence provided by each, as well as the results. CABG = coronary artery bypass graft; ICA = invasive coronary angiography; PCI = percutaneous coronary intervention; Rx = prescription.
Figure 2
Figure 2. Proportion of Patients With Obstructive Coronary Artery Disease Found on Elective Cardiac Catheterization Following Noninvasive Testing for Suspected Cardiac Chest Pain Across Multiple Studies
Obstructive coronary disease was defined as having at least 1 stenosis of > 50% of an epicardial coronary artery measuring ≥2 mm in diameter (12,41-43). Dates represent the time frames during which patient data was accrued. CCTA = coronary computed tomography angiography; FFRCT = fractional flow reserve computed tomography NCDR = National Cardiovascular Data Registry; PROMISE = PROspective Multicenter Imaging Study for Evaluation of chest pain trial; Outcome and Resource Impacts; VA = Veterans Affairs.
Central Illustration
Central Illustration
Comparison of diagnostic tools the Evaluation of Chest Pain: Levels of Evidence of SCOT HEART and PROMISE. Main results and conclusions from the SCOT-HEART and PROMISE trials.
See this image and copyright information in PMC

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