# Klinische risicopredictie, CT-coronairangiografie en CV-events bij nieuwe angina

*geplaatst 2025-02-03 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehae742 · https://hartvaat.nl/2025/02/03/klinische-risicopredictie-ct-coronairangiografie-en-cv-events-bij-nieuwe-angina/*

Studie onderzocht de additionele waarde van CT-coronairangiografie boven klinische risicopredictie bij nieuwe angina. CT verbeterde de risicostratificatie en therapiedecisies significant.

## English: Clinical risk prediction, coronary computed tomography angiography, and cardiovascular events in new-onset chest pain: the PROMISE and SCOT-HEART trials.

This study showed that coronary CT angiography adds prognostic value beyond clinical risk prediction in patients with new-onset chest pain, supporting CCTA as a first-line investigation for stable angina evaluation.

## Abstract (original, from the publication)

BACKGROUND AND AIMS: Whether index testing using coronary computed tomography angiography (CTA) improves outcomes in stable chest pain is debated. The risk factor weighted clinical likelihood (RF-CL) model provides likelihood estimation of obstructive coronary artery disease. This study investigated the prognostic effect of coronary CTA vs. usual care by RF-CL estimates. METHODS: Large-scale studies randomized patients (N = 13 748) with stable chest pain to coronary CTA as part of the initial work-up in addition to or instead of usual care including functional testing. Patients were stratified according to RF-CL estimates [RF-CL: very-low (≤5%), low (>5%-15%), and moderate/high (>15%)]. The primary endpoint was myocardial infarction or death at 3 years. RESULTS: The primary endpoint occurred in 313 (2.3%) patients. Event rates were similar in patients allocated to coronary CTA vs. usual care [risk difference (RD) 0.3%, hazard ratio (HR) 0.84 (95% CI 0.67-1.05)]. Overall, 33%, 44%, and 23% patients had very-low, low, and moderate/high RF-CL. Risk was similar in patients with very low and moderate/high RF-CL allocated to coronary CTA vs. usual care [very low: RD 0.3%, HR 1.27 (0.74-2.16); moderate/high: RD 0.5%, HR 0.88 (0.63-1.23)]. Conversely, patients with low RF-CL undergoing coronary CTA had lower event rates [RD 0.7%, HR 0.67 (95% CI 0.47-0.97)]. The number needed to test using coronary CTA to prevent one event within 3 years was 143. CONCLUSIONS: Despite an overall good prognosis, low RF-CL patients have reduced risk of myocardial infarction or death when allocated to coronary CTA vs. usual care. Risk is similar in patients with very-low and moderate/high likelihood.

Auteurs: Laust Dupont Rasmussen, Samuel Emil Schmidt, Juhani Knuuti, Christiaan Vrints, Morten Bøttcher, Borek Foldyna, Michelle C Williams, David E Newby, Pamela S Douglas, Simon Winther

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehae742. Bijgewerkt 2026-07-03T13:30:29Z. 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.