Survival After Initial Stress Testing vs Anatomic Testing in Suspected Coronary Artery Disease

作者：Pamela S. Douglas, Amanda Stebbins, Borek Foldyna, Manesh R. Patel, Daniel B. Mark, Michael T. Lu, Udo Hoffmann, Svati H. Shah, Beth Martinez, Brooke Alhanti, Neha J. Pagidipati · 发表于：JAMA Cardiology · 年份：2025 · DOI：10.1001/jamacardio.2025.2882 · 被引用次数：4 · 研究领域：Cardiac Imaging and Diagnostics、Coronary Interventions and Diagnostics、Acute Myocardial Infarction Research

Importance: Symptoms suggestive of coronary artery disease (CAD) often require noninvasive testing for diagnostic and prognostic evaluation. Objective: To determine long-term outcomes in patients randomized to functional (stress) vs anatomic (coronary computed tomographic angiography [CTA]) initial testing. Design, Setting, and Participants: This study is a 2025 follow-up analysis of mortality of participants in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) randomized clinical trial, which was conducted from 2009 to 2014, using a 2024 National Death Index search. Median (IQR) follow-up duration was 10.6 (9.9-11.3) years; maximum follow-up was 12.4 years. PROMISE was conducted at 193 multispecialty outpatient sites in North America among 10 003 symptomatic patients requiring testing for suspected CAD. Data analysis was conducted from August 2024 to March 2025. Intervention: Participants were randomized 1:1 to initial CTA or stress testing. Testing and subsequent care were performed by sites according to usual practices. Main Outcomes and Measures: The PROMISE trial's original primary end point was death, myocardial infarction, unstable angina hospitalization, or major procedural complication. The primary end point for extended follow-up was all-cause death, with cardiovascular (CV) death as a secondary end point. Results: At enrollment, mean (SD) participant age was 61 (8) years, 5270 participants (52.7%) were women, and 8762 (87.6%) had ches...