The Experts below are selected from a list of 129666 Experts worldwide ranked by ideXlab platform
Daniel B Mark - One of the best experts on this subject based on the ideXlab platform.
-
safety of coronary ct angiography and Functional Testing for stable chest pain in the promise trial a randomized comparison of test complications incidental findings and radiation dose
Journal of Cardiovascular Computed Tomography, 2017Co-Authors: Michael T Lu, Pamela S Douglas, Daniel B Mark, James E Udelson, Elizabeth C Adami, Brian B Ghoshhajra, Michael H Picard, Rhonda Roberts, Andrew J Einstein, Eric J VelazquezAbstract:Abstract Background Coronary computed tomography angiography (CTA) and Functional Testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety. Methods We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and Functional Testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other Functional tests if randomized to the Functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose. Results Of 9470 patients, none had major and Conclusion Complications were negligibly rare for both CTA and Functional Testing. CTA detects more incidental findings. Compared to nuclear stress Testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550 ).
-
safety of coronary ct angiography and Functional Testing for stable chest pain in the promise trial a randomized comparison of test complications incidental findings and radiation dose
Journal of Cardiovascular Computed Tomography, 2017Co-Authors: Pamela S Douglas, Daniel B Mark, Kerry L Lee, James E Udelson, Elizabeth C Adami, Brian B Ghoshhajra, Michael H Picard, Rhonda Roberts, Andrew J Einstein, Eric J VelazquezAbstract:Abstract Background Coronary computed tomography angiography (CTA) and Functional Testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety. Methods We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and Functional Testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other Functional tests if randomized to the Functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose. Results Of 9470 patients, none had major and Conclusion Complications were negligibly rare for both CTA and Functional Testing. CTA detects more incidental findings. Compared to nuclear stress Testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550 ).
-
changes in medical therapy and lifestyle after anatomical or Functional Testing for coronary artery disease
Journal of the American Heart Association, 2016Co-Authors: Udo Hoffmann, Daniel B Mark, Rowena J Dolor, Megan Huang, Joseph A Ladapo, Kerry L Lee, Adrian Coles, Robert A Pelberg, Matthew J BudoffAbstract:Background Diagnostic Testing in the care of patients newly presenting with symptoms suggestive of coronary artery disease may influence risk factor management, independent of test type or test results. However, little is known about changes in medications and lifestyle after anatomical or Functional Testing. Methods and Results We examined what factors influenced preventive medical therapy and lifestyle practices at 60 days among 10 003 symptomatic patients (53% women; mean age 61 years) randomly assigned to anatomical Testing with coronary computed tomographic angiography or Functional Testing (NCT01174550). We also assessed the association of preventive changes with major cardiovascular events. There were no differences in medications/lifestyle at baseline. At 60 days, relative to baseline, the computed tomographic angiography strategy was associated with a higher proportion of patients newly initiating aspirin (11.8% versus 7.8%), statins (12.7% versus 6.2%), and β‐blockers (8.1% versus 5.3%), compared to Functional Testing ( P P =0.002) while obese/overweight status was lower ( P =0.040). Positive initial test results and revascularization demonstrated stronger associations with preventive medications and lifestyle than test type. Medication initiation was not associated with fewer cardiovascular events. Conclusions Positive initial test results and revascularization are primary drivers of changes in preventive medical and lifestyle practices, with test type making secondary contributions. However, substantial opportunities exist to further reduce cardiovascular risk. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01174550.
-
abstract 14051 changes in medical therapy and lifestyle after anatomical versus Functional Testing for coronary artery disease the promise trial prospective multicenter imaging study for evaluation of chest pain
Circulation, 2015Co-Authors: Joseph A Ladapo, Udo Hoffmann, Daniel B Mark, Rowena J Dolor, Megan Huang, Kerry L Lee, Adrian Coles, Robert A Pelberg, Matthew J Budoff, Gardar SigurdssonAbstract:Introduction: Diagnostic Testing may represent a “teachable moment” for patients newly presenting with symptoms suggestive of CAD and requiring further evaluation, and may influence risk factor management, independent of test results. However, little is known about changes in medications and lifestyle after anatomical versus Functional Testing. Hypothesis: Patients assigned to coronary CTA will report greater use of preventive medications and lifestyle practices. Methods: We randomly assigned 10,003 symptomatic patients (53% women; mean age 61 yrs) to anatomical Testing with CTA or Functional Testing (exercise ECG, nuclear stress, or stress echocardiography). We assessed use of preventive medications (aspirin, statin, beta blocker, and ACEi/ARB) and lifestyle practices (heart healthy diet, regular exercise, smoking, and obese/overweight status [BMI>25]) at 60 days. Chi-square tests assessed between-group changes (initiation or discontinuation). Multivariable logistic regression models assessed the association between Testing strategy and prevalence of medication use or lifestyle practices. Results: There were no differences in medications or lifestyle practices at baseline. At 60 days, the CTA strategy was associated with a higher proportion of patients newly initiating aspirin (11.6% vs 7.6%), statin (12.7% vs 6.2%), and beta blockers (8.2% vs 5.4%), compared to Functional Testing (p Conclusions: Among patients with suspected CAD, anatomical Testing is associated with greater favorable changes in preventive medical and lifestyle practices. This may represent a long term benefit of a CTA Testing strategy.
-
abstract 18053 prognostic value of anatomic versus Functional diagnostic Testing in symptomatic patients with suspected cad the promise trial prospective multicenter imaging study for evaluation of chest pain
Circulation, 2015Co-Authors: Udo Hoffmann, Manesh R Patel, Daniel B Mark, Megan Huang, James E Udelson, Michael H Picard, Maros Ferencik, John F Heitner, Michael J Pencina, Christopher B FordyceAbstract:Introduction: Symptoms suggestive of coronary artery disease (CAD) are common, but no randomized comparison of the prognostic value of coronary computed tomographic angiography (CTA) vs. Functional Testing has been performed. Methods: Patients (10,003) with suspected CAD were randomized to Functional Testing (exercise ECG, nuclear stress, or stress echo) or CTA. Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. Cox proportional hazards models assessed the relationship of test results to a composite of time to death, myocardial infarction, or unstable angina, and the discriminatory ability of the two tests was compared using the C-index. Adjusted HRs for events in patients with abnormal vs. normal test results were determined for CTA and Functional Testing. Results: Overall, 4516 patients received CTA and 4572 Functional Testing as the randomized diagnostic test. The proportions of normal, mild, moderate, and severe abnormalities on CTA were 33.3%, 42...
Eric J Velazquez - One of the best experts on this subject based on the ideXlab platform.
-
a phenomapping derived tool to personalize the selection of anatomical vs Functional Testing in evaluating chest pain assist
European Heart Journal, 2021Co-Authors: Evangelos Oikonomou, David Van Dijk, Helen Parise, Marc A Suchard, James A De Lemos, Charalambos Antoniades, Eric J Velazquez, Edward J Miller, Rohan KheraAbstract:AIMS Coronary artery disease is frequently diagnosed following evaluation of stable chest pain with anatomical or Functional Testing. A more granular understanding of patient phenotypes that benefit from either strategy may enable personalized Testing. METHODS AND RESULTS Using participant-level data from 9572 patients undergoing anatomical (n = 4734) vs. Functional (n = 4838) Testing in the PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) trial, we created a topological representation of the study population based on 57 pre-randomization variables. Within each patient's 5% topological neighbourhood, Cox regression models provided individual patient-centred hazard ratios for major adverse cardiovascular events and revealed marked heterogeneity across the phenomap [median 1.11 (10th to 90th percentile: 0.52-2.61]), suggestive of distinct phenotypic neighbourhoods favouring anatomical or Functional Testing. Based on this risk phenomap, we employed an extreme gradient boosting algorithm in 80% of the PROMISE population to predict the personalized benefit of anatomical vs. Functional Testing using 12 model-derived, routinely collected variables and created a decision support tool named ASSIST (Anatomical vs. Stress Testing decIsion Support Tool). In both the remaining 20% of PROMISE and an external validation set consisting of patients from SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) undergoing anatomical-first vs. Functional-first assessment, the Testing strategy recommended by ASSIST was associated with a significantly lower incidence of each study's primary endpoint (P = 0.0024 and P = 0.0321 for interaction, respectively), as well as a harmonized endpoint of all-cause mortality or non-fatal myocardial infarction (P = 0.0309 and P < 0.0001 for interaction, respectively). CONCLUSION We propose a novel phenomapping-derived decision support tool to standardize the selection of anatomical vs. Functional Testing in the evaluation of stable chest pain, validated in two large and geographically diverse clinical trial populations.
-
safety of coronary ct angiography and Functional Testing for stable chest pain in the promise trial a randomized comparison of test complications incidental findings and radiation dose
Journal of Cardiovascular Computed Tomography, 2017Co-Authors: Michael T Lu, Pamela S Douglas, Daniel B Mark, James E Udelson, Elizabeth C Adami, Brian B Ghoshhajra, Michael H Picard, Rhonda Roberts, Andrew J Einstein, Eric J VelazquezAbstract:Abstract Background Coronary computed tomography angiography (CTA) and Functional Testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety. Methods We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and Functional Testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other Functional tests if randomized to the Functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose. Results Of 9470 patients, none had major and Conclusion Complications were negligibly rare for both CTA and Functional Testing. CTA detects more incidental findings. Compared to nuclear stress Testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550 ).
-
safety of coronary ct angiography and Functional Testing for stable chest pain in the promise trial a randomized comparison of test complications incidental findings and radiation dose
Journal of Cardiovascular Computed Tomography, 2017Co-Authors: Pamela S Douglas, Daniel B Mark, Kerry L Lee, James E Udelson, Elizabeth C Adami, Brian B Ghoshhajra, Michael H Picard, Rhonda Roberts, Andrew J Einstein, Eric J VelazquezAbstract:Abstract Background Coronary computed tomography angiography (CTA) and Functional Testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety. Methods We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and Functional Testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other Functional tests if randomized to the Functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose. Results Of 9470 patients, none had major and Conclusion Complications were negligibly rare for both CTA and Functional Testing. CTA detects more incidental findings. Compared to nuclear stress Testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550 ).
Udo Hoffmann - One of the best experts on this subject based on the ideXlab platform.
-
erratum to outcomes of anatomical vs Functional Testing for coronary artery disease lessons from the major trials
Herz, 2020Co-Authors: Jana Taron, Julia Karady, Andreas A Kammerlander, Udo HoffmannAbstract:In the above-mentioned article, in the section "Other randomized controlled studies, meta-analyses, and registry data" two subheadings were swapped by mistake. The sections concerned must instead be headed as ….
-
changes in medical therapy and lifestyle after anatomical or Functional Testing for coronary artery disease
Journal of the American Heart Association, 2016Co-Authors: Udo Hoffmann, Daniel B Mark, Rowena J Dolor, Megan Huang, Joseph A Ladapo, Kerry L Lee, Adrian Coles, Robert A Pelberg, Matthew J BudoffAbstract:Background Diagnostic Testing in the care of patients newly presenting with symptoms suggestive of coronary artery disease may influence risk factor management, independent of test type or test results. However, little is known about changes in medications and lifestyle after anatomical or Functional Testing. Methods and Results We examined what factors influenced preventive medical therapy and lifestyle practices at 60 days among 10 003 symptomatic patients (53% women; mean age 61 years) randomly assigned to anatomical Testing with coronary computed tomographic angiography or Functional Testing (NCT01174550). We also assessed the association of preventive changes with major cardiovascular events. There were no differences in medications/lifestyle at baseline. At 60 days, relative to baseline, the computed tomographic angiography strategy was associated with a higher proportion of patients newly initiating aspirin (11.8% versus 7.8%), statins (12.7% versus 6.2%), and β‐blockers (8.1% versus 5.3%), compared to Functional Testing ( P P =0.002) while obese/overweight status was lower ( P =0.040). Positive initial test results and revascularization demonstrated stronger associations with preventive medications and lifestyle than test type. Medication initiation was not associated with fewer cardiovascular events. Conclusions Positive initial test results and revascularization are primary drivers of changes in preventive medical and lifestyle practices, with test type making secondary contributions. However, substantial opportunities exist to further reduce cardiovascular risk. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01174550.
-
outcomes of anatomical vs Functional Testing for coronary artery disease lessons from the promise trial
Herz, 2016Co-Authors: Ravi V Shah, Borek Foldyna, Udo HoffmannAbstract:The development of coronary artery disease (CAD) is a major, final common pathway in heart disease worldwide. With a rise in stress Testing and increased scrutiny on cost-effectiveness and radiation exposure in medical imaging, a focus on the relative merits of anatomic versus Functional characterization of CAD has emerged. In this context, coronary computed tomography angiography (CCTA) is a noninvasive alternative to Functional Testing as a first-line test for CAD detection but is complimentary in its nature. Here, we discuss the design, results, and implications of the PROMISE trial, a randomized comparative effectiveness study of 10,003 patients across 193 sites in the United States and Canada comparing the prognostic and diagnostic power of CCTA and standard stress Testing. Specifically, we discuss the safety (e. g., contrast, radiation exposure) of CCTA versus Functional Testing in CAD, the need for improved selection for noninvasive Testing, the frequency of downstream Testing after anatomic or Functional imaging, the use of imaging results in clinical management, and novel modalities of CAD risk determination using CCTA. PROMISE demonstrated that in a real-world, low-to-intermediate risk patient population referred to noninvasive Testing for CAD, both CCTA and Functional Testing approaches have similar clinical, economic, and safety-based outcomes. We conclude with open questions in CAD imaging, specifically as they pertain to the utilization of CCTA.
-
abstract 14051 changes in medical therapy and lifestyle after anatomical versus Functional Testing for coronary artery disease the promise trial prospective multicenter imaging study for evaluation of chest pain
Circulation, 2015Co-Authors: Joseph A Ladapo, Udo Hoffmann, Daniel B Mark, Rowena J Dolor, Megan Huang, Kerry L Lee, Adrian Coles, Robert A Pelberg, Matthew J Budoff, Gardar SigurdssonAbstract:Introduction: Diagnostic Testing may represent a “teachable moment” for patients newly presenting with symptoms suggestive of CAD and requiring further evaluation, and may influence risk factor management, independent of test results. However, little is known about changes in medications and lifestyle after anatomical versus Functional Testing. Hypothesis: Patients assigned to coronary CTA will report greater use of preventive medications and lifestyle practices. Methods: We randomly assigned 10,003 symptomatic patients (53% women; mean age 61 yrs) to anatomical Testing with CTA or Functional Testing (exercise ECG, nuclear stress, or stress echocardiography). We assessed use of preventive medications (aspirin, statin, beta blocker, and ACEi/ARB) and lifestyle practices (heart healthy diet, regular exercise, smoking, and obese/overweight status [BMI>25]) at 60 days. Chi-square tests assessed between-group changes (initiation or discontinuation). Multivariable logistic regression models assessed the association between Testing strategy and prevalence of medication use or lifestyle practices. Results: There were no differences in medications or lifestyle practices at baseline. At 60 days, the CTA strategy was associated with a higher proportion of patients newly initiating aspirin (11.6% vs 7.6%), statin (12.7% vs 6.2%), and beta blockers (8.2% vs 5.4%), compared to Functional Testing (p Conclusions: Among patients with suspected CAD, anatomical Testing is associated with greater favorable changes in preventive medical and lifestyle practices. This may represent a long term benefit of a CTA Testing strategy.
-
abstract 18053 prognostic value of anatomic versus Functional diagnostic Testing in symptomatic patients with suspected cad the promise trial prospective multicenter imaging study for evaluation of chest pain
Circulation, 2015Co-Authors: Udo Hoffmann, Manesh R Patel, Daniel B Mark, Megan Huang, James E Udelson, Michael H Picard, Maros Ferencik, John F Heitner, Michael J Pencina, Christopher B FordyceAbstract:Introduction: Symptoms suggestive of coronary artery disease (CAD) are common, but no randomized comparison of the prognostic value of coronary computed tomographic angiography (CTA) vs. Functional Testing has been performed. Methods: Patients (10,003) with suspected CAD were randomized to Functional Testing (exercise ECG, nuclear stress, or stress echo) or CTA. Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. Cox proportional hazards models assessed the relationship of test results to a composite of time to death, myocardial infarction, or unstable angina, and the discriminatory ability of the two tests was compared using the C-index. Adjusted HRs for events in patients with abnormal vs. normal test results were determined for CTA and Functional Testing. Results: Overall, 4516 patients received CTA and 4572 Functional Testing as the randomized diagnostic test. The proportions of normal, mild, moderate, and severe abnormalities on CTA were 33.3%, 42...
Pamela S Douglas - One of the best experts on this subject based on the ideXlab platform.
-
safety of coronary ct angiography and Functional Testing for stable chest pain in the promise trial a randomized comparison of test complications incidental findings and radiation dose
Journal of Cardiovascular Computed Tomography, 2017Co-Authors: Pamela S Douglas, Daniel B Mark, Kerry L Lee, James E Udelson, Elizabeth C Adami, Brian B Ghoshhajra, Michael H Picard, Rhonda Roberts, Andrew J Einstein, Eric J VelazquezAbstract:Abstract Background Coronary computed tomography angiography (CTA) and Functional Testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety. Methods We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and Functional Testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other Functional tests if randomized to the Functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose. Results Of 9470 patients, none had major and Conclusion Complications were negligibly rare for both CTA and Functional Testing. CTA detects more incidental findings. Compared to nuclear stress Testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550 ).
-
safety of coronary ct angiography and Functional Testing for stable chest pain in the promise trial a randomized comparison of test complications incidental findings and radiation dose
Journal of Cardiovascular Computed Tomography, 2017Co-Authors: Michael T Lu, Pamela S Douglas, Daniel B Mark, James E Udelson, Elizabeth C Adami, Brian B Ghoshhajra, Michael H Picard, Rhonda Roberts, Andrew J Einstein, Eric J VelazquezAbstract:Abstract Background Coronary computed tomography angiography (CTA) and Functional Testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety. Methods We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and Functional Testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other Functional tests if randomized to the Functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose. Results Of 9470 patients, none had major and Conclusion Complications were negligibly rare for both CTA and Functional Testing. CTA detects more incidental findings. Compared to nuclear stress Testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550 ).
-
outcomes of anatomical versus Functional Testing for coronary artery disease
The New England Journal of Medicine, 2015Co-Authors: Pamela S Douglas, Udo Hoffmann, Manesh R Patel, Daniel B Mark, Hussein R Alkhalidi, Brendan Cavanaugh, Jason Cole, Rowena J Dolor, Christopher B Fordyce, Megan HuangAbstract:BACKGROUND Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic Testing, although there are limited data from randomized trials to guide care. METHODS We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical Testing with the use of coronary computed tomographic angiography (CTA) or to Functional Testing (exercise electrocardiography, nuclear stress Testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. RESULTS The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the Functional-Testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P = 0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was Functional Testing (3.4% vs. 4.3%, P = 0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the Functional-Testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the Functional-Testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). CONCLUSIONS In symptomatic patients with suspected CAD who required noninvasive Testing, a strategy of initial CTA, as compared with Functional Testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the National Heart, Lung, and Blood Institute; PROMISE ClinicalTrials.gov number, NCT01174550.)
Megan Huang - One of the best experts on this subject based on the ideXlab platform.
-
changes in medical therapy and lifestyle after anatomical or Functional Testing for coronary artery disease
Journal of the American Heart Association, 2016Co-Authors: Udo Hoffmann, Daniel B Mark, Rowena J Dolor, Megan Huang, Joseph A Ladapo, Kerry L Lee, Adrian Coles, Robert A Pelberg, Matthew J BudoffAbstract:Background Diagnostic Testing in the care of patients newly presenting with symptoms suggestive of coronary artery disease may influence risk factor management, independent of test type or test results. However, little is known about changes in medications and lifestyle after anatomical or Functional Testing. Methods and Results We examined what factors influenced preventive medical therapy and lifestyle practices at 60 days among 10 003 symptomatic patients (53% women; mean age 61 years) randomly assigned to anatomical Testing with coronary computed tomographic angiography or Functional Testing (NCT01174550). We also assessed the association of preventive changes with major cardiovascular events. There were no differences in medications/lifestyle at baseline. At 60 days, relative to baseline, the computed tomographic angiography strategy was associated with a higher proportion of patients newly initiating aspirin (11.8% versus 7.8%), statins (12.7% versus 6.2%), and β‐blockers (8.1% versus 5.3%), compared to Functional Testing ( P P =0.002) while obese/overweight status was lower ( P =0.040). Positive initial test results and revascularization demonstrated stronger associations with preventive medications and lifestyle than test type. Medication initiation was not associated with fewer cardiovascular events. Conclusions Positive initial test results and revascularization are primary drivers of changes in preventive medical and lifestyle practices, with test type making secondary contributions. However, substantial opportunities exist to further reduce cardiovascular risk. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01174550.
-
abstract 14051 changes in medical therapy and lifestyle after anatomical versus Functional Testing for coronary artery disease the promise trial prospective multicenter imaging study for evaluation of chest pain
Circulation, 2015Co-Authors: Joseph A Ladapo, Udo Hoffmann, Daniel B Mark, Rowena J Dolor, Megan Huang, Kerry L Lee, Adrian Coles, Robert A Pelberg, Matthew J Budoff, Gardar SigurdssonAbstract:Introduction: Diagnostic Testing may represent a “teachable moment” for patients newly presenting with symptoms suggestive of CAD and requiring further evaluation, and may influence risk factor management, independent of test results. However, little is known about changes in medications and lifestyle after anatomical versus Functional Testing. Hypothesis: Patients assigned to coronary CTA will report greater use of preventive medications and lifestyle practices. Methods: We randomly assigned 10,003 symptomatic patients (53% women; mean age 61 yrs) to anatomical Testing with CTA or Functional Testing (exercise ECG, nuclear stress, or stress echocardiography). We assessed use of preventive medications (aspirin, statin, beta blocker, and ACEi/ARB) and lifestyle practices (heart healthy diet, regular exercise, smoking, and obese/overweight status [BMI>25]) at 60 days. Chi-square tests assessed between-group changes (initiation or discontinuation). Multivariable logistic regression models assessed the association between Testing strategy and prevalence of medication use or lifestyle practices. Results: There were no differences in medications or lifestyle practices at baseline. At 60 days, the CTA strategy was associated with a higher proportion of patients newly initiating aspirin (11.6% vs 7.6%), statin (12.7% vs 6.2%), and beta blockers (8.2% vs 5.4%), compared to Functional Testing (p Conclusions: Among patients with suspected CAD, anatomical Testing is associated with greater favorable changes in preventive medical and lifestyle practices. This may represent a long term benefit of a CTA Testing strategy.
-
abstract 18053 prognostic value of anatomic versus Functional diagnostic Testing in symptomatic patients with suspected cad the promise trial prospective multicenter imaging study for evaluation of chest pain
Circulation, 2015Co-Authors: Udo Hoffmann, Manesh R Patel, Daniel B Mark, Megan Huang, James E Udelson, Michael H Picard, Maros Ferencik, John F Heitner, Michael J Pencina, Christopher B FordyceAbstract:Introduction: Symptoms suggestive of coronary artery disease (CAD) are common, but no randomized comparison of the prognostic value of coronary computed tomographic angiography (CTA) vs. Functional Testing has been performed. Methods: Patients (10,003) with suspected CAD were randomized to Functional Testing (exercise ECG, nuclear stress, or stress echo) or CTA. Site-based diagnostic test reports were classified as normal or mildly, moderately, or severely abnormal. Cox proportional hazards models assessed the relationship of test results to a composite of time to death, myocardial infarction, or unstable angina, and the discriminatory ability of the two tests was compared using the C-index. Adjusted HRs for events in patients with abnormal vs. normal test results were determined for CTA and Functional Testing. Results: Overall, 4516 patients received CTA and 4572 Functional Testing as the randomized diagnostic test. The proportions of normal, mild, moderate, and severe abnormalities on CTA were 33.3%, 42...
-
outcomes of anatomical versus Functional Testing for coronary artery disease
The New England Journal of Medicine, 2015Co-Authors: Pamela S Douglas, Udo Hoffmann, Manesh R Patel, Daniel B Mark, Hussein R Alkhalidi, Brendan Cavanaugh, Jason Cole, Rowena J Dolor, Christopher B Fordyce, Megan HuangAbstract:BACKGROUND Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic Testing, although there are limited data from randomized trials to guide care. METHODS We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical Testing with the use of coronary computed tomographic angiography (CTA) or to Functional Testing (exercise electrocardiography, nuclear stress Testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. RESULTS The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the Functional-Testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P = 0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was Functional Testing (3.4% vs. 4.3%, P = 0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the Functional-Testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the Functional-Testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). CONCLUSIONS In symptomatic patients with suspected CAD who required noninvasive Testing, a strategy of initial CTA, as compared with Functional Testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the National Heart, Lung, and Blood Institute; PROMISE ClinicalTrials.gov number, NCT01174550.)
