In my over 35 years of heart patient care, including 25 years using innovations in the cardiac catheterizaiton laboratory, it is my opinion that Coronary CT Angiography (CCTA) with AI interpretation (Cleerly Health) is the most important breakthrough for accurate diagnosis and disease tracking. I have ordered hundreds if not thousands of these scans since the introduction of the AI technology in 2020.
Now, one of the
early studies of CCTA reports on 10 year follow up of patients randomized to early CCTA or observation and the results are both important and validate the Kahn Center approach.
STUDY
SCOT-HEART was an open-label, multicentre, parallel group trial for which patients were recruited from 12 outpatient cardiology chest pain clinics across Scotland. Eligible patients were aged 18–75 years with symptoms of suspected stable angina due to coronary heart disease. Patients were randomly assigned (1:1) to standard of care plus CCTA or standard of care alone.
In this prespecified 10-year analysis, prescribing data, coronary procedural interventions, and clinical outcomes were obtained through record linkage from national registries.
RESULTS
Between 2010-2014, 4146 patients were recruited, with 2073 randomly assigned to standard care and CCTA and 2073 to standard care alone.
After a median of 10 years , coronary heart disease death or non-fatal myocardial infarction was less frequent in the CCTA group compared with the standard care group (137 [6·6%] vs 171 [8·2%).
Rates of all-cause, cardiovascular, and coronary heart disease death, and non-fatal stroke, were similar between the groups, but non-fatal myocardial infarctions (90 [4·3%] vs 124 [6·0%] and major adverse cardiovascular events (172 [8·3%] vs 214 [10·3%] were less frequent in the CCTA group.
Rates of coronary revascularisation procedures were similar but preventive therapy prescribing remained more frequent in the CCTA group.
DISCUSSION
After 10 years, CCTA-guided management of patients with stable chest pain was associated with a sustained reduction in coronary heart disease death or non-fatal myocardial infarction.
Identification of coronary atherosclerosis by CCTA improves long-term cardiovascular disease prevention in patients with stable chest pain.
Professor Bryan Williams, Chief Scientific and Medical Officer of the British Heart Foundation, said: “This study is a brilliant illustration of the vital role that research plays in unlocking new ways of preventing, diagnosing and treating heart and circulatory diseases. It’s not just here in the UK that SCOT-HEART has had an impact, this study has driven implementation of CCTA scans globally.
“Thanks to the introduction of CCTA scans, which BHF funding helped to make possible, doctors are able to identify and treat people at risk of heart attacks at an earlier stage – before they become patients. Ultimately, this means thousands of people are living for longer in good health, and families get to spend more time with their loved ones.”
Patient care needs to be individualized. CCTA does expose patients to radiation and iodine contrast and requires a low and steady heart rate for a few seconds. It is also not covered by insurance in many patients but the recent addition of Medicare coverage for the Cleerly AI interpretation will help.
I have found this remarkable technology to be crucial for accurate diagnosis and for tracking patient response to therapies, lifestyle and pharmacological.
