- Question
- Does adding CT coronary angiography (CTCA) to standard care improve the diagnosis, management, and outcomes of patients with suspected angina due to coronary heart disease?
- Design
- Prospective, open-label, parallel-group, multicentre trial with 1:1 randomization through a web-based service ensuring allocation concealment. Conducted in 12 cardiology chest pain clinics across Scotland; 4146 patients were randomized and analysis was by intention to treat.
- Population
- Patients aged 18 to 75 years referred for assessment of suspected angina due to coronary heart disease. At baseline, 47% had a clinic diagnosis of coronary heart disease and 36% of angina due to coronary heart disease.
- Intervention
- Standard care plus CTCA.
- Control
- Standard care alone.
- Primary outcome
- Certainty of the diagnosis of angina secondary to coronary heart disease at 6 weeks.
- Results
- CTCA reclassified the diagnosis of coronary heart disease in 558 patients (27%) and of angina due to coronary heart disease in 481 (23%), versus 22 (1%) and 23 (1%) with standard care (p<0.0001). Certainty of the angina diagnosis increased (RR 1.79, 95% CI 1.62-1.96; p<0.0001). At 1.7 years, CTCA was associated with fewer fatal and non-fatal myocardial infarctions (26 vs 42; HR 0.62, 95% CI 0.38-1.01; p=0.0527), which was not statistically significant.
- Conclusion
- In patients with suspected angina due to coronary heart disease, CTCA clarifies the diagnosis and enables targeting of interventions, and might reduce the future risk of myocardial infarction.
- Why it matters
- The trial provided early evidence that incorporating CTCA into the assessment of stable chest pain changes diagnosis and treatment decisions, and supported wider use of the technique in clinical practice.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026