Coronary CT angiography works just as well as traditional stress testing over the long haul for patients with stable symptoms of coronary artery disease. That’s according to the latest follow-up data from the PROMISE study in JAMA Cardiology, which found no difference in mortality between either strategy.
PROMISE was a randomized controlled trial that compared patient work-up with anatomical CCTA scans to functional stress testing (exercise ECG, stress echo, or stress nuclear) in 10k patients from 2010 to 2014.
- The first PROMISE results found that in patients with CAD symptoms who were followed up for just over two years, there was little difference between anatomical CCTA and functional stress testing for endpoints like death, myocardial infarction, or other complications.
But what about over a longer follow-up period? The new results extend PROMISE’s follow-up to a median of 10.6 years, finding…
- Mortality rates were largely the same whether patients got CCTA or stress testing (14.3% vs. 14.5%, p = 0.56).
- Cardiovascular mortality rates were also similar (4.0% vs. 4.3%, p = 0.77).
- As were noncardiovascular death rates (10.7% for both).
There were some differences in the predictive power of each modality based on patient characteristics…
- With CCTA, any abnormal finding increased a patient’s mortality risk compared to normal findings for severe, moderate, and mild disease (HR = 3.44, 3.38, and 1.99, respectively).
- With stress testing, only patients with severely abnormal disease had higher mortality risk (HR = 1.45).
The new PROMISE data also tracks well with recent 10-year findings from SCOT-HEART, another major study that demonstrated CCTA’s value.
- Combining results from PROMISE and SCOT-HEART shows 89% survival of patients with stable angina at 12 years, demonstrating good effectiveness regardless of workup strategy.
The Takeaway
PROMISE findings have gone a long way toward showing that CCTA is every bit as effective as stress testing, and the new results reinforce this message. The findings are also good news for radiology, which has a stronger hold over anatomical imaging with CT than it does over the predominant stress modalities, which are largely controlled by cardiology.
