SCCT Statement on the SCOT-HEART (Scottish Computed Tomography of the Heart) Trial, Presented at the ACC Scientific Sessions

                                                                                                               

SAN DIEGO (March 16, 2015) - Today at the American College of Cardiology (ACC) Annual Scientific Sessions in San Diego, results from the SCOT-HEART clinical trial reported highly encouraging findings as to the effectiveness of CCTA (coronary computed tomographic angiography) as compared to conventional stress testing.  This is now the second large randomized trial in two days showing very positive findings regarding CCTA, providing strong evidence that will likely impact both clinical guidelines and reimbursement rules in the future.

 

SCCT President Ricardo C. Cury, MD, FSCCT (Miami) commented that "this is an extremely important trial that adds major knowledge to the work-up of chest pain patients and adds above and beyond the recently presented PROMISE trial.  SCOT-HEART demonstrated that CCTA provided a clearer and more precise diagnosis of coronary heart disease (CHD), reclassifying the diagnosis in one of every 4 patients."  

 

Dr. Cury further noted that "the use of CCTA led to changes in treatment strategies, resulting in a 38% reduction on CHD death and non-fatal myocardial infarction (MI) when compared to the standard of care.  Although this fell just short of statistical significance, the findings are very encouraging and will need to be confirmed by longer term follow-up.  The Scottish investigators should be commended for a well designed and conducted clinical trial."  On a further positive note, Dr. Cury emphasized that median radiation dose for CCTA was only 4.1 mSv, continuing the rapidly accelerating downward trend thanks to technological advances and rigorous professional training.

 

Further elaborating on CCTA's impact on myocardial infarctions (heart attacks) during the SCOT-HEART trial, SCCT Vice President, Leslee J. Shaw, Ph.D (Atlanta) observed that "amazingly, CCTA was associated with the sizable 38% reduction in MI.  Although the statistical significance of this finding was borderline, these findings support the likelihood that CCTA can identify high risk plaque that may be a harbinger of an acute coronary event."

 

In sum, Dr. Shaw stressed, "both SCOT HEART and PROMISE provide compelling evidence that CCTA should be part of the everyday testing armamentarium for evaluating patients with chest pain.  These results provide convincing evidence to revise coverage and medical necessity decision rules:  CCTA is of high clinical value in identifying high risk plaque, determining the existence (and severity) of coronary stenosis, and improving clinical outcomes of symptomatic patients."

 

Coronary CTA is an imaging method that uses a computed tomography (CT) scanner to non-invasively and painlessly examine the structure and blood vessels of the heart.  While this technology has been in use for many years elsewhere in the body, recent advances in CT scanners now enable highly trained physicians and technologists to take and interpret three-dimensional images of the beating heart with extraordinary clarity and detail.  With these recent advances, a coronary CTA now can replace the need for an exercise stress test or an invasive cardiac catheterization and angiogram. 

 

SCOT-HEART was a large prospective multi-center trial in 4,146 patients presenting with suspected angina due to coronary heart disease in twelve cardiology outpatient clinics in Scotland.  Patients were randomized to standard of care (including functional imaging) OR standard of care PLUS CCTA.  As the study directors noted, addition of CCTA to standard care clarified the diagnosis of angina due to CHD.  CCTA thus reduced the need for additional stressed testing, increased the use of invasive coronary angiography in appropriate circumstances, and led to more focused treatment, associated with a 38% reduction in heart attacks as compared to standard of care.