McKavanagh P, Lusk L, Ball P A, Verghis R M, Agus A M, Trinick T R, Duly E, Walls G M, Stevenson M, James B, Hamilton A, Harbinson M T, Donnelly P M
Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK Centre for Vision and Vascular Science, Institute of Clinical Science A, Queen's University Belfast, Royal Victoria Hospital Belfast, Belfast BT126BA, UK
Cardiology Department, Ulster Hospital, South Eastern Health and Social Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, UK.
Eur Heart J Cardiovasc Imaging. 2015 Apr;16(4):441-8. doi: 10.1093/ehjci/jeu284. Epub 2014 Dec 3.
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.
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.
Cardiac CT as an index investigation for stable chest pain improved angina symptoms and resulted in fewer investigations and re-hospitalizations compared with EST.
确定在稳定型胸痛患者中，与传统运动应激心电图测试（EST）相比，基于心脏计算机断层扫描（CT）的新型诊断途径所导致的症状和预后差异。
一项前瞻性随机对照试验比较了EST组和心脏CT冠状动脉造影组的选定患者结局。招募了500名肌钙蛋白阴性的稳定型胸痛且无已知冠状动脉疾病的患者。患者在基线、3个月和12个月时完成西雅图心绞痛问卷（SAQ）以评估心绞痛症状。还对患者的治疗策略和临床事件进行了随访。在这一年中，有12名患者退出，导致EST队列中有245名患者，CT队列中有243名患者。基线人口统计学特征无显著差异。CT组在3个月和12个月时SAQ的心绞痛稳定性和生活质量领域存在统计学差异，表明与EST组相比心绞痛更少。在CT组中，发现的疾病更显著，血管重建更多。值得注意的是，EST组的不确定结果更多，额外检查的数量也更多。平均治疗时间也更长。两组之间的主要不良心脏事件无差异。在EST组的1年时，急诊（A&E）就诊和心脏住院的情况更多。
与EST相比，心脏CT作为稳定型胸痛的索引检查可改善心绞痛症状，并减少检查和再次住院的次数。
