Clinical outcomes and cost-effectiveness of a diagnostic and treatment strategy of upfront CTCA plus selective non-invasive functional imaging compared with standard care in patients with chest pain and suspected coronary artery disease

What is the clinical effect and cost-effectiveness of a combined diagnostic and
treatment strategy in patients with suspected coronary artery disease (CAD)?
This strategy comprises of upfront computed tomography coronary angiography
(CTCA) with selective non-invasive functional imaging and patient tailored
therapy.

This strategy will result in a reduction reduce the incidence of major adverse
cardiovascular events (MACE) defined as death or non-fatal myocardial
infarction and appear more efficient than care as usual.

Randomized controlled trial (RCT)

Upfront CTCA with standardized reporting through CAD-RADS classification.
CAD-RADS 0 rules-out CAD. CAD-RADS 1 & 2 rules-out obstructive CAD with high
certainty and optimal preventive drug therapy (OMT) is then initiated. In
patients CAD-RADS =3, obstructive CAD is assumed and OMT will be started with
additional anti-anginal medication (OMT +). In this latter group, additional
non-invasive functional imaging will be performed if anginal complaints
persist under OMT +. Patients with> 10% myocardial ischemia on imaging will
undergo revascularization in consultation with the cardiac team.

Please see page 25 of the research protocol (Chapter 11.3: Benefits and risks
assessment, group relatedness)