The following is a summary of “Comparison of an Initial Risk-Based Testing Strategy vs Usual Testing in Stable Symptomatic Patients With Suspected Coronary Artery Disease,” published in the August 2023 issue of Cardiology by Douglas et al. 

For a study, researchers aimed to assess an altered initial cCTA (computed tomography angiography) approach to enhance clinical efficiency compared to standard or usual testing (UT). The patients with stable symptoms suggesting coronary artery disease (CAD) and no prior testing were randomly split into two groups (PS and UT) across 65 sites in North America and Europe.

Researchers enrolled 2,103 participants, with an average age of 58.4 years, of which 1,056 were male (50.2%). Approximately 20.1% (422 individuals) were classified as minimal risk. The primary outcome occurred in 44 participants (4.2%) in the preventive strategy (PS) group and 118 participants (11.3%) in the usual care (UT) group. 

The PS approach showed higher clinical efficiency, leading to lower catheterization rates without obstructive disease than UT. The safety composite of death/MI (myocardial infarction) was similar between both groups. Notably, slight differences between the PS and UT groups were observed in death and nonfatal MI rates.

The new chest pain diagnosis method, which involves initially assessing the risk quantitatively and delaying tests for individuals at minimal risk and using cCTA alongside selective FFR-CT for other patients, showed improved clinical efficiency compared to UT after one year. Further randomized clinical trials are required to confirm these results, particularly in evaluating safety.

Source: jamanetwork.com/journals/jamacardiology/fullarticle/2808765