Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland.

Summary

In SCOT-HEART’s 10-year analysis (n=4146), adding CCTA to standard care reduced coronary heart disease death or non-fatal MI (HR 0.79), driven by fewer non-fatal MIs and MACE, with similar revascularization rates but sustained increases in preventive therapy use.

Key Findings

• Primary outcome (CHD death or non-fatal MI) reduced with CCTA vs standard care (6.6% vs 8.2%; HR 0.79; p=0.044) over median 10 years.
• Non-fatal MI (HR 0.72; p=0.017) and MACE (HR 0.80; p=0.026) were lower with CCTA; revascularization rates were similar.
• Preventive therapies remained more frequently prescribed in the CCTA group (OR 1.17; p=0.034).

Clinical Implications

CCTA should be considered in stable chest pain evaluation to refine diagnosis and intensify preventive therapy, expecting sustained reductions in non-fatal MI and MACE over a decade.

Limitations

• Open-label design could introduce management biases
• No significant differences in all-cause or cardiovascular mortality; modest p-value for primary outcome

Future Directions

Assess cost-effectiveness across health systems; define populations with maximal benefit; integrate plaque characterization and AI-based risk stratification to further optimize prevention.