The following is a summary of “Deferred Testing in Stable Outpatients With Suspected Coronary Artery Disease. A Prespecified Secondary Analysis of the PRECISE Randomized Clinical Trial,” published in the August 2023 issue of Cardiology by Udelson et al.
No randomized trial has previously examined the deferral of testing for symptomatic individuals with suspected coronary artery disease (CAD) despite guideline recommendations. For a study, researchers evaluated the process of care and health outcomes in people identified as minimal risk for CAD through the PROMISE minimal risk score (PMRS) at multiple sites in North America and Europe.
Among 2,103 participants, 422 were considered minimal risk (20%) and divided into deferred testing (n = 214) or usual testing (n = 208) groups. The mean age was 46 years; 72% were women. During follow-up, 64% in the deferred group didn’t undergo testing, while 36% had tests due to various reasons. Most results (96%) were normal. The primary endpoint occurred in 0.9% in the deferred group and 6.3% in the usual group.
No deaths or heart attacks happened in the deferred group, while one non-cardiovascular death and one heart attack occurred in the usual testing group. Fewer individuals had non-obstructive catheterizations in the deferred group (0.9%) compared to the usual group (5.8%). Both groups showed a similar reduction in frequent chest pain at 12 months compared to baseline (70% to less than 20%).
Researchers concluded that identifying minimal risk via PMRS in those with suspected CAD allowed a safe strategy of deferred testing. It resulted in no adverse events, fewer unnecessary catheterizations, and comparable symptom relief compared to the standard testing approach.
Source: jamanetwork.com/journals/jamacardiology/article-abstract/2808764
