Coronary CTA Fails to Live Up to Its PROMISE in Suspected CAD

March 14, 2015 8:25 PM

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Coronary CTA Fails to Live Up to Its PROMISE in Suspected CAD

In the PROMISE trial, investigators led by Pamela S. Douglas, MD, of Duke University School of Medicine (Durham, NC), randomized 10,003 symptomatic patients (87.7% with chest pain) without diagnosed CAD to an initial strategy of coronary CTA or functional testing (exercise ECG, nuclear stress testing, or stress echocardiography) at 193 North American centers from July 27, 2010, through September 19, 2013. Mean patient age was 60.8 years and 52.7% were female. Given the substantial burden of cardiovascular risk factors in the population—patients had a mean of 2.4 risk factors each—the pretest likelihood of obstructive CAD was 53.3%.

In the coronary CTA arm (n = 4,996), 93.8% underwent CTA as an initial test while 2.9% had a functional test and 3.1% had no test. Nine patients in this arm went directly to catheterization. In the functional testing arm (n = 5,007), the initial testing strategy was a stress test in 93.7%, CTA in 0....

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