Table 1

Summary of Primary Endpoint Findings From Randomized Clinical Trials in Stable Ischemic Heart Disease

Trial Name (Ref. #)RandomizationN, Total and by ArmIntervention DetailsDuration of Follow-Up, yrsMajor EndpointHR (95% CI)
p Value
CECaT (20)Invasive angiography vs. stress echocardiography, SPECT, or CMR1:1 randomization (N = 898)
Angiography n = 222 vs. echocardiography n = 226,
SPECT n = 224, or CMR n = 226
Invasive angiography was the comparator vs. SPECT, echocardiography, and CMR2.0All-cause mortalityp = 0.054
CRESCENT (36)Coronary CTA vs. exercise ECG2:1 randomization (N = 350)
Coronary CTA = 242 vs. exercise ECG = 108
Coronary CTA arm included index CAC evaluation with Coronary CTA limited to CAC >01.0All-cause mortality, MI, major stroke, unstable angina, unplanned CAD evaluation, or late revascularization0.32 (0.13–0.81)
p = 0.011
PROMISE (18)Anatomic (Coronary CTA) vs. functional test strategy1:1 randomization (N = 10,003)
Coronary CTA n = 4,996 vs. stress test n = 5,007
Clinician choice:
67% nuclear, 23% echocardiography, 10% ECG
2.1Death, MI, unstable angina hospitalization, or major complications1.04 (0.83–1.29)
p = 0.75
SCOT-HEART (19)SC + Coronary CTA vs. SC1:1 randomization (N = 4,146)
SC + Coronary CTA = 2,073 vs. SC = 2,073
Index evaluation often included exercise ECG (85%)1.7Primary: certainty of angina diagnosis caused by CAD
Secondary: coronary heart disease death or MI
0.62 (0.38–1.01)
p = 0.053
WOMEN (33)Exercise SPECT vs. exercise ECG1:1 randomization (N = 824)
SPECT n = 412 vs. ECG n = 412
Inclusion of women with DASI estimate ≥5 METs2.0CAD death, MI, or hospitalization for acute coronary syndrome or heart failure1.3 (0.5–3.5)
p = 0.59

CAC = coronary artery calcium; CAD = coronary artery disease; CECaT = Cost-Effectiveness of noninvasive Cardiac Testing; CI = confidence interval; CMR = cardiac magnetic resonance; CRESCENT = Computed Tomography vs. Exercise Testing in Suspected Coronary Artery Disease; CTA = computed tomographic angiography; DASI = Duke Activity Status Index; ECG = electrocardiogram; HR = hazard ratio; MET = metabolic equivalents; MI = myocardial infarction; PROMISE = Prospective Multicenter Imaging Study for Evaluation of Chest Pain; SC = standard care; SCOT-HEART = Scottish Computed Tomography of the HEART; SPECT = single-photon emission computed tomography; WOMEN = What is the Optimal Method of Ischemia Elucidation in Women?

  • Duration of follow-up is reported as median values for PROMISE and SCOT-HEART.

  • Primary endpoint is reported for all but SCOT-HEART and CECaT trials where outcomes are a secondary endpoint.

  • No HR was reported from the CECaT trial. However, the HR for angiography vs. stress CMR was elevated 2.6-fold (95% CI: 1.1 to 6.2) but not significant for angiography vs. stress echocardiography or SPECT.