Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease Pamela S. Douglas, M.D., Udo Hoffmann, M.D., M.P.H., Manesh R. Patel, M.D.,

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Presentation transcript:

Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease Pamela S. Douglas, M.D., Udo Hoffmann, M.D., M.P.H., Manesh R. Patel, M.D., Daniel B. Mark, M.D., M.P.H.,Hussein R. Al-Khalidi, Ph.D., Brendan Cavanaugh, M.D., Jason Cole, M.D., Rowena J. Dolor, M.D.,Christopher B. Fordyce, M.D., Megan Huang, Ph.D., Muhammad Akram Khan, M.D., Andrzej S. Kosinski, Ph.D.,Mitchell W. Krucoff, M.D., Vinay Malhotra, M.D., Michael H. Picard, M.D., James E. Udelson, M.D.,Eric J. Velazquez, M.D., Eric Yow, M.S., Lawton S. Cooper, M.D., M.P.H., and Kerry L. Lee, Ph.D.,for the PROMISE Investigators The NEW ENGLAND JOURNAL of MEDICINE APRIL 2,2015 VOL.372 NO.14 R3 최윤영 /Prof. 김진배

Introduction New-onset, stable chest pain : Common clinical problem Coronary computed tomographic angiography(CTA) : Unique ability to detect important The relative impact of data from noninvasive anatomical testing versus functional test : not known

Methods STUDY DESIGN 193 enrolling sites in North America STUDY PARTICIPANTS 10,003 symptomatic patients without diagnosed CAD whose physicians Men : More than 54years Women : More than 64years At least one cardiac risk factor Men : 45 to 54 years Women : 50 to 64 years

Methods DIAGNOSTIC TESTING Functional test : Exercise electrocardiography(ECG) : Exercise or pharmacologic nuclear stress testing : Stress echocardiography Anatomical test : Contrast-enhanced CTA

Methods EFFECTIVENESS AND SAFETY END POINTS The primary end points : Death, myocardial infarction, hospitalization for unstable angina, major complication of cardiovascular procedures Secondary end points : Invasive cardiac catheterization that did not show obstructive CAD and radiation exposure

fatigue or weakness, arm or shoulder pain, palpitations, dizziness or light-hadedness, or neck or jaw pain

Conclusion In symptomatic patients with suspected CAD who required noninvasive testing, an initial strategy of CTA was not associated with better clinical outcomes than functional testing over a median follow-up of 2 years.