Adding a simple imaging test to standard practice could reduce risk of heart attack and death in patients with recurrent chest pain by 41%, based on results of a five-year study published in the New England Journal of Medicine.
Known as the SCOT-HEART study, this study tested the impact of coronary computed tomographic angiography (CTA) in patients with chest pain. This exam, which is a type of CT imaging, is a non-invasive test that looks at the heart’s arteries. It uses a powerful X-ray machine to produce multiple images of the heart and is typically used to diagnose the cause of chest pain.
Since CT imaging provides useful information about patients’ heart health, it has been shown to improve both treatment and outcomes. However, findings have been mixed and involve mostly short-term outcomes.
To learn more, the SCOT-HEART trial randomly assigned 4,146 middle-aged patients with chest pain to CT imaging plus standard care or standard care alone, and then followed them for an average of five years.
Participants came from 12 medical centers across Scotland and were treated for stable chest pain, which is typically brought on by physical activity or stress. While stable chest pain is not considered a medical emergency, it can be a sign of poor blood flow to the heart and requires monitoring and treatment.
By the end of the study, only 2.3% of participants in the imaging group had experienced heart attack or heart-related death, compared to 3.9% in the standard care group. Analysis showed that imaging helped reduce risk of heart attack and death by 41% compared to standard care alone.
According to authors, this may be thanks to the fact that patients receiving imaging were 40% more likely to receive preventive therapies like aspirin and statins and 27% more likely to receive medication for chest pain. These types of treatments are known to reduce risk for heart events and improve outcomes in patients with heart disease.
Authors also note that in the first few months of follow-up, participants undergoing imaging were more likely to undergo invasive procedures like coronary angiography and coronary revascularization. These procedures help diagnose and treat blocked arteries and are generally used in patients at high risk for heart disease. However, rates of these procedures leveled out by the end of the study, with similar procedure rates in both groups after five years.
Based on findings, authors conclude that CT imaging helps greatly improve outcomes in patients with stable chest pain without increasing rates of invasive procedures.
CTA is non-invasive and only takes about 15 minutes, making it a simple add-on to standard care. The main risk is exposure to radiation, although exposure is relatively low. In the U.S. this test may or may not be covered by insurance, which limits its current use.
While additional research is needed, findings support the use of CT imaging in combination with standard care for patients with recurrent chest pain. Authors hope that eventually adding imaging will help improve both quality of life and survival for patients struggling with recurrent chest pain.