A comparison of cardiac computerized tomography and exercise stress electrocardiogramtest for the investigation of stable chest pain: The clinical results of the CAPP randomized prospective trial

P. McKavanagh*, L. Lusk, P. A. Ball, R. M. Verghis, A. M. Agus, T. R. Trinick, E. Duly, G. M. Walls, M. Stevenson, B. James, A. Hamilton, M. T. Harbinson, P. M. Donnelly

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

62 Citations (Scopus)

Abstract

Aims To determine the symptomatic and prognostic differences resulting from a novel diagnostic pathway based on cardiac computerized tomography (CT) compared with the traditional exercise stress electrocardiography test (EST) in stable chest pain patients. Methods and results A prospective randomized controlled trial compared selected patient outcomes in EST and cardiac CT coronary angiography groups. Five hundred patients with troponin-negative stable chest pain and without known coronary artery disease were recruited. Patients completed the Seattle Angina Questionnaires (SAQ) at baseline, 3, and 12 months to assess angina symptoms. Patients were also followed for management strategies and clinical events. Over the year 12 patients withdrew, resulting in 245 in the EST cohort and 243 in the CT cohort. There was no significant difference in baseline demographics. The CT arm had a statistical difference in angina stability and quality-of-life domains of the SAQ at 3 and12 months, suggesting less angina compared with the EST arm. In the CT arm, there was more significant disease identified and more revascularizations. Significantly, more inconclusive results were seen in the EST arm with a higher number of additional investigations ordered. There was also a longer mean time to management. There were no differences in major adverse cardiac events between the cohorts. At 1 year in the EST arm, there were more Accident and Emergency (A&E) attendances and cardiac admission. Conclusion Cardiac CTas an index investigation for stable chest pain improved angina symptoms and resulted in fewer investigations and re-hospitalizations compared with EST. Clinical trial registration http://www.controlled-trials.com/ISRCTN52480460.

Original languageEnglish
Pages (from-to)441-448
JournalEuropean Heart Journal Cardiovascular Imaging
Volume16
Issue number4
Early online date03 Dec 2014
DOIs
Publication statusPublished - Apr 2015

Keywords

  • Cardiac computerized tomography
  • Exercise stress electrocardiogram
  • Stable chest pain

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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