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Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE

  • Cardiac PET, CT, and MRI (SE Petersen and F Pugliese, Section Editors)
  • Published:
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Abstract

The PROMISE (Prospective multicenter imaging study for evaluation of chest pain) trial compared the effectiveness of coronary CT angiography and functional testing as initial diagnostic test for patients with suspicion for stable coronary artery disease (CAD). With 10,003 patients randomized at 193 sites, the PROMISE trial provides a snapshot of real-world care for this very common presentation. Over a median follow-up of 25 months, PROMISE did not find significant differences in major clinical events (composite endpoint 164 vs. 151, HR 1.04 (0.83–1.29); p = 0.75) between the two strategies. Other major findings were the large discrepancy between estimates of pre-test likelihood and observed prevalence for obstructive CAD (≥50 %) and the proportion of noninvasive tests positive for ischemia or obstructive CAD (53 vs. 11 %; respectively) and the better efficiency of coronary computed tomography angiography (CTA) to select patients for invasive coronary angiography (ICA) who had obstructive CAD (72 vs. 48 % for coronary CTA and functional testing, respectively). Radiation exposure was higher in the CT arm compared to all functional testing but lower than for nuclear perfusion stress testing. Improvement of patient selection for diagnostic testing and risk stratification will be keys to increase efficacy and efficiency of management of patients with suspicion for stable CAD.

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Abbreviations

95%CI:

95 % confidence interval

CAD:

Coronary artery disease

CTA:

CT angiography

CVD:

Cardiovascular disease

FFR:

Fractional flow reserve

HR:

Hazard ratio

ICA:

Invasive coronary angiography

MACE:

Major adverse cardiac event

OMT:

Optimal medical therapy

PCI:

Percutaneous coronary intervention

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Acknowledgments

Maros Ferencik reports receiving the following award (American Heart Association Fellow to Faculty Award 13FTF16450001).

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Authors and Affiliations

  1. Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA

    Daniel O. Bittner & Udo Hoffmann

  2. Department of Medicine 2 - Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany

    Daniel O. Bittner

  3. Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA

    Maros Ferencik

  4. Duke Clinical Research Institute, Duke University School of Medicine, Columbus, OH, USA

    Pamela S. Douglas

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  1. Daniel O. Bittner
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  2. Maros Ferencik
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  3. Pamela S. Douglas
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  4. Udo Hoffmann
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Correspondence to Daniel O. Bittner.

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Conflict of Interest

Daniel O. Bittner and Maros Ferencik declare that they have no conflict of interest.

Udo Hoffmann reports grants from HeartFlow, Siemens HealthCare, and ACRIN, as well as fees from the AHA.

Pamela S. Douglas reports grants from HeartFlow, and grants and DSMB membership for GE HealthCare.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Cardiac PET, CT, and MRI

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Bittner, D.O., Ferencik, M., Douglas, P.S. et al. Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspective from a Multicenter Randomized Controlled Trial: PROMISE. Curr Cardiol Rep 18, 40 (2016). https://doi.org/10.1007/s11886-016-0718-9

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  • DOI: https://doi.org/10.1007/s11886-016-0718-9

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