CRESCENT
Trial question
What is the role of tiered cardiac CT protocol in patients with suspected stable coronary artery disease?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
32.0% female
68.0% male
N = 350
350 patients (111 female, 239 male).
Inclusion criteria: adult patients with suspected stable coronary artery disease.
Key exclusion criteria: known coronary artery disease; invasive angiography; stress testing performed within the last year.
Interventions
N=242 tiered cardiac CT protocol (a calcium scan followed by CTA if the Agatston calcium score is 1-400).
N=108 functional testing (standard diagnostic management, including stress testing and/or invasive angiography).
Primary outcome
Clinical effectiveness
39%
25%
39.0 %
29.3 %
19.5 %
9.8 %
0.0 %
Tiered cardiac CT
protocol
Functional
testing
Significant
increase ▲
NNT = 7
Significant increase in clinical effectiveness (39% vs. 25%; RR 1.56, 95% CI 0.34 to 2.78).
Secondary outcomes
No significant difference in diagnostic yield of invasive angiography (72% vs. 58%; AD 14%, 95% CI -23.13 to 51.13).
Significant decrease in downstream testing (25% vs. 53%; ARD -28, 95% CI -41.99 to -14.01).
Significant increase in the rate of event-free survival at 1.2 years (96.7% vs. 89.8%; AD 6.9%, 95% CI 1.58 to 12.22).
Safety outcomes
No significant differences in death, non-fatal MI, unstable angina, non-fatal stroke.
Significant difference in total adverse events (3% vs. 10%).
Conclusion
In adult patients with suspected stable coronary artery disease, tiered cardiac CT protocol was superior to functional testing with respect to clinical effectiveness.
Reference
Marisa Lubbers, Admir Dedic, Adriaan Coenen et al. Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial. Eur Heart J. 2016 Apr 14;37(15):1232-43.
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