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Coronary Computed Tomography Angiography Compared With Single Photon Emission Computed Tomography Myocardial Perfusion Imaging as a Guide to Optimal Medical Therapy in Patients Presenting With Stable Angina: The RESCUE Trial.
J Am Heart Assoc. 2020 12 15; 9(24):e017993.JA

Abstract

Background The RESCUE (Randomized Evaluation of Patients with Stable Angina Comparing Utilization of Noninvasive Examinations) trial was a randomized, controlled, multicenter, comparative efficacy outcomes trial designed to assess whether initial testing with coronary computed tomographic angiography (CCTA) is noninferior to single photon emission computed tomography (SPECT) myocardial perfusion imaging in directing patients with stable angina to optimal medical therapy alone or optimal medical therapy with revascularization. Methods and Results The end point was first major adverse cardiovascular event (MACE) (cardiac death or myocardial infarction), or revascularization. Noninferiority margin for CCTA was set a priori as a hazard ratio (HR) of 1.3 (95% CI=0, 1.605). One thousand fifty participants from 44 sites were randomized to CCTA (n=518) or SPECT (n=532). Mean follow-up time was 16.2 (SD 7.9) months. There were no cardiac-related deaths. In patients with a negative CCTA there was 1 acute myocardial infarction; in patients with a negative SPECT examination there were 2 acute myocardial infarctions; and for positive CCTA and SPECT, 1 acute myocardial infarction each. Participants in the CCTA arm had a similar rate of MACE or revascularization compared with those in the SPECT myocardial perfusion imaging arm, (HR, 1.03; 95% CI=0.61-1.75) (P=0.19). CCTA segment involvement by a stenosis of ≥50% diameter was a better predictor of MACE and revascularization at 1 year (P=0.02) than the percent reversible defect size by SPECT myocardial perfusion imaging. Four (1.2%) patients with negative CCTA compared with 14 (3.2%) with negative SPECT had MACE or revascularization (P=0.03). Conclusions There was no difference in outcomes of patients who had stable angina and who underwent CCTA in comparison to SPECT as the first imaging test directing them to optimal medical therapy alone or with revascularization. CCTA was a better predictor of MACE and revascularization. Registration Information URL: https://www.clinicaltrials.gov/. Identifier: NCT01262625.

Authors+Show Affiliations

Department of Radiology and Imaging Sciences Emory University Atlanta GA.Department of Biostatistics Brown University School of Public Health Providence RI. Center for Statistical Sciences Brown University School of Public Health Providence RI.Departments of Medicine and Radiology Johns Hopkins University Baltimore MD.Department of Biostatistics Brown University School of Public Health Providence RI. Center for Statistical Sciences Brown University School of Public Health Providence RI.Center for Statistical Sciences Brown University School of Public Health Providence RI.Center for Statistical Sciences Brown University School of Public Health Providence RI.Pulse Heart Institute Tacoma WA.Department of Radiology University of Pennsylvania Boston MA.Division of Cardiology Tufts-New England Medical Center Boston MA.Department of Radiology Massachusetts General Hospital Boston MA.Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis MO.No affiliation info available

Pub Type(s)

Clinical Trial, Phase III
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

33283579

Citation

Stillman, Arthur E., et al. "Coronary Computed Tomography Angiography Compared With Single Photon Emission Computed Tomography Myocardial Perfusion Imaging as a Guide to Optimal Medical Therapy in Patients Presenting With Stable Angina: the RESCUE Trial." Journal of the American Heart Association, vol. 9, no. 24, 2020, pp. e017993.
Stillman AE, Gatsonis C, Lima JAC, et al. Coronary Computed Tomography Angiography Compared With Single Photon Emission Computed Tomography Myocardial Perfusion Imaging as a Guide to Optimal Medical Therapy in Patients Presenting With Stable Angina: The RESCUE Trial. J Am Heart Assoc. 2020;9(24):e017993.
Stillman, A. E., Gatsonis, C., Lima, J. A. C., Liu, T., Snyder, B. S., Cormack, J., Malholtra, V., Schnall, M. D., Udelson, J. E., Hoffmann, U., & Woodard, P. K. (2020). Coronary Computed Tomography Angiography Compared With Single Photon Emission Computed Tomography Myocardial Perfusion Imaging as a Guide to Optimal Medical Therapy in Patients Presenting With Stable Angina: The RESCUE Trial. Journal of the American Heart Association, 9(24), e017993. https://doi.org/10.1161/JAHA.120.017993
Stillman AE, et al. Coronary Computed Tomography Angiography Compared With Single Photon Emission Computed Tomography Myocardial Perfusion Imaging as a Guide to Optimal Medical Therapy in Patients Presenting With Stable Angina: the RESCUE Trial. J Am Heart Assoc. 2020 12 15;9(24):e017993. PubMed PMID: 33283579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coronary Computed Tomography Angiography Compared With Single Photon Emission Computed Tomography Myocardial Perfusion Imaging as a Guide to Optimal Medical Therapy in Patients Presenting With Stable Angina: The RESCUE Trial. AU - Stillman,Arthur E, AU - Gatsonis,Constantine, AU - Lima,Joao A C, AU - Liu,Tao, AU - Snyder,Bradley S, AU - Cormack,Jean, AU - Malholtra,Vinay, AU - Schnall,Mitchell D, AU - Udelson,James E, AU - Hoffmann,Udo, AU - Woodard,Pamela K, AU - ,, Y1 - 2020/12/05/ PY - 2020/12/8/pubmed PY - 2021/3/16/medline PY - 2020/12/7/entrez KW - angina KW - cardiovascular imaging KW - coronary computed tomography angiography KW - coronary revascularization KW - ischemia KW - nuclear medicine SP - e017993 EP - e017993 JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 9 IS - 24 N2 - Background The RESCUE (Randomized Evaluation of Patients with Stable Angina Comparing Utilization of Noninvasive Examinations) trial was a randomized, controlled, multicenter, comparative efficacy outcomes trial designed to assess whether initial testing with coronary computed tomographic angiography (CCTA) is noninferior to single photon emission computed tomography (SPECT) myocardial perfusion imaging in directing patients with stable angina to optimal medical therapy alone or optimal medical therapy with revascularization. Methods and Results The end point was first major adverse cardiovascular event (MACE) (cardiac death or myocardial infarction), or revascularization. Noninferiority margin for CCTA was set a priori as a hazard ratio (HR) of 1.3 (95% CI=0, 1.605). One thousand fifty participants from 44 sites were randomized to CCTA (n=518) or SPECT (n=532). Mean follow-up time was 16.2 (SD 7.9) months. There were no cardiac-related deaths. In patients with a negative CCTA there was 1 acute myocardial infarction; in patients with a negative SPECT examination there were 2 acute myocardial infarctions; and for positive CCTA and SPECT, 1 acute myocardial infarction each. Participants in the CCTA arm had a similar rate of MACE or revascularization compared with those in the SPECT myocardial perfusion imaging arm, (HR, 1.03; 95% CI=0.61-1.75) (P=0.19). CCTA segment involvement by a stenosis of ≥50% diameter was a better predictor of MACE and revascularization at 1 year (P=0.02) than the percent reversible defect size by SPECT myocardial perfusion imaging. Four (1.2%) patients with negative CCTA compared with 14 (3.2%) with negative SPECT had MACE or revascularization (P=0.03). Conclusions There was no difference in outcomes of patients who had stable angina and who underwent CCTA in comparison to SPECT as the first imaging test directing them to optimal medical therapy alone or with revascularization. CCTA was a better predictor of MACE and revascularization. Registration Information URL: https://www.clinicaltrials.gov/. Identifier: NCT01262625. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/33283579/Coronary_Computed_Tomography_Angiography_Compared_With_Single_Photon_Emission_Computed_Tomography_Myocardial_Perfusion_Imaging_as_a_Guide_to_Optimal_Medical_Therapy_in_Patients_Presenting_With_Stable_Angina:_The_RESCUE_Trial. L2 - https://www.ahajournals.org/doi/10.1161/JAHA.120.017993?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -