{"id":"e0ed559715be","type":"article","url":"https://hartvaat.nl/2025/01/25/scot-heart-ct-coronairangiografie-bij-stabiele-thoracale-pijn-tienjaarsresultate/","title":"SCOT-HEART: CT-coronairangiografie bij stabiele thoracale pijn — tienjaarsresultaten","title_en":"Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT-HEART randomised controlled trial in Scotland.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["coronaire-ct-angiografie","stabiel-coronairlijden"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(24)02679-5","source_url":"https://doi.org/10.1016/S0140-6736(24)02679-5","authors":["Michelle C Williams","Ryan Wereski","Christopher Tuck","Philip D Adamson","Anoop S V Shah","Edwin J R van Beek","Giles Roditi","Colin Berry","Nicholas Boon","Marcus Flather","Steff Lewis","John Norrie","Adam D Timmis","Nicholas L Mills","Marc R Dweck","David E Newby"],"significance":8,"published":"2025-01-25","source_date":"2025-01-25","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/","https://hartvaat.nl/kennis/diagnostiek/cardiale-ct-angiografie/"],"congress":"","summary_en":"The 10-year SCOT-HEART follow-up confirmed that coronary CT angiography-guided management of stable chest pain provides sustained cardiovascular benefit, with persistent reductions in MI. The long-term data support CCTA as a cost-effective first-line investigation.","created":"2026-07-03T10:31:27Z","updated":"2026-07-03T13:30:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Tienjaars follow-up van SCOT-HEART bevestigde dat CT-coronairangiografie bij stabiele thoracale pijn de cardiovasculaire uitkomsten verbetert. Het voordeel bleef duurzaam, wat CT als diagnostische standaard bij stabiele angina ondersteunt.","abstract_original":"BACKGROUND: The Scottish Computed Tomography of the Heart (SCOT-HEART) trial demonstrated that management guided by coronary CT angiography (CCTA) improved the diagnosis, management, and outcome of patients with stable chest pain. We aimed to assess whether CCTA-guided care results in sustained long-term improvements in management and outcomes. METHODS: SCOT-HEART was an open-label, multicentre, parallel group trial for which patients were recruited from 12 outpatient cardiology chest pain clinics across Scotland. Eligible patients were aged 18-75 years with symptoms of suspected stable angina due to coronary heart disease. Patients were randomly assigned (1:1) to standard of care plus CCTA or standard of care alone. In this prespecified 10-year analysis, prescribing data, coronary procedural interventions, and clinical outcomes were obtained through record linkage from national registries. The primary outcome was coronary heart disease death or non-fatal myocardial infarction on an intention-to-treat basis. This trial is registered at ClinicalTrials.gov (NCT01149590) and is complete. FINDINGS: Between Nov 18, 2010, and Sept 24, 2014, 4146 patients were recruited (mean age 57 years [SD 10], 2325 [56·1%] male, 1821 [43·9%] female), with 2073 randomly assigned to standard care and CCTA and 2073 to standard care alone. After a median of 10·0 years (IQR 9·3-11·0), coronary heart disease death or non-fatal myocardial infarction was less frequent in the CCTA group compared with the standard care group (137 [6·6%] vs 171 [8·2%]; hazard ratio [HR] 0·79 [95% CI 0·63-0·99], p=0·044). Rates of all-cause, cardiovascular, and coronary heart disease death, and non-fatal stroke, were similar between the groups (p>0·05 for all), but non-fatal myocardial infarctions (90 [4·3%] vs 124 [6·0%]; HR 0·72 [0·55-0·94], p=0·017) and major adverse cardiovascular events (172 [8·3%] vs 214 [10·3%]; HR 0·80 [0·65-0·97], p=0·026) were less frequent in the CCTA group. Rates of coronary revascularisation procedures were similar (315 [15·2%] vs 318 [15·3%]; HR 1·00 [0·86-1·17], p=0·99) but preventive therapy prescribing remained more frequent in the CCTA group (831 [55·9%] of 1486 vs 728 [49·0%] of 1485 patients with available data; odds ratio 1·17 [95% CI 1·01-1·36], p=0·034). INTERPRETATION: After 10 years, CCTA-guided management of patients with stable chest pain was associated with a sustained reduction in coronary heart disease death or non-fatal myocardial infarction. Identification of coronary atherosclerosis by CCTA improves long-term cardiovascular disease prevention in patients with stable chest pain. FUNDING: The Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Edinburgh and Lothian's Health Foundation Trust, British Heart Foundation, and Heart Diseases Research Fund."}