Medical Research: What are the main findings of the study?
Dr. Budoff: We evaluated whether patients undergoing coronary CT angiography (non-invasive angiography) had better outcomes than those treated without the test. We found survival was better with CT angiography. Finding atherosclerosis allows cardiologists and primary care doctors to treat the patient better, including more statin therapy, more anti-platelet therapy, more lifestyle modifications. Several small studies showed similar results, but this was by far the most significant and largest study of it’s kind.
Medical Research: What was most surprising about the results?
Dr. Budoff: The magnitude of benefit. Patients were MUCH less likely to die if they underwent a CT angiogram.
Medical Research: What should clinicians and patients take away from your report?
Dr. Budoff: Finding the plaque in the coronaries directly is much better for doctors to make decisions about medications, stents, bypass and lifestyle. The old methods of evaluating coronary artery disease, by looking at stress tests and only identifying patients with high grade stenosis (more than 50% or 70% blockages) is not adequate. Many plaques that rupture and cause MI and death are only 20-50% in severity, and these would be missed by treadmill, nuclear scan or echocardiography. We know from the COURAGE trial that we can successfully treat atherosclerosis with aggressive medical therapy, but we need to make the diagnosis to know who to treat. This is what CT angiography allows.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Budoff: Prospective studies of CT angiography vs standard of care need to be undertaken, especially in regard to compliance and findings of subclinical atherosclerosis.
Our hypothesis of why people live longer undergoing cardiac CT is both more accurate diagnosis and identification of subclinical (<50% blockages) atherosclerosis, but also better adherence to medications. Patients who see the plaque are more likely to stay on medications, but what is the long term adherence rates of those undergoing CTA vs standard of care, and does this influence outcomes.
Coronary CT angiography Versus Standard of Care Strategies to evaluate patients with potential coronary artery disease; Effect on long term clinical outcomes
Budoff, Matthew J. et al