R.E.B.E.L.EM - October 22, 2018 - By Salim Rezaie
"...Clinical Take Home Point: Because CTCA is an anatomic test, it appears to increase the certainty and frequency of coronary heart disease identification, which in turn changes treatment with preventative and anti-anginal medications, but also leads to more coronary angiography and revascularization in the short term (12months). With the newer AHA recommendations for lowered thresholds of preventative medication initiation, since the publication of the original SCOT-HEART study, it is not clear if CTCA would still result in improved long term outcomes. Additionally, with SCOT-HEART’s primary 5-year endpoint being driven by decreased non-fatal MI, an outcome that may be differently adjudicated based on the data ascertained from CTCA, even this improvement is suspect. Generally, with the publication of SCOT-HEART, the addition of CTCA to standard care can be definitively determined to have little benefit except to mitigate diagnostic uncertainty—a clinician-oriented benefit with minimal patient value. The only question that remains unanswered now is, does the initiation of preventative therapies (aspirin, statins, lifestyle modifications), coronary revascularization, or a combination of both strategies improve long-term patient oriented outcomes in patients with stable chest pain due to coronary heart disease?"