Outcomes in patients with a first episode of chest pain undergoing early coronary CT imaging

Klaske R Siegersma, N Charlotte Onland-Moret, Yolande Appelman, Pim van der Harst, Igor I Tulevski, G Aernout Somsen, Jagat Narula, Hester M den Ruijter, Leonard Hofstra

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OBJECTIVES: To investigate the impact of a CT-first strategy on all-cause and cardiovascular mortality in patients presenting with chest pain in outpatient cardiology clinics.

METHODS: Patients with a first presentation of suspected angina pectoris were identified and their data linked to the registrations of Statistics Netherlands for information on mortality. The linked database consisted of 33 068 patients. CT-first patients were defined as patients with a CT calcium score and coronary CT angiography, within 6 weeks after their initial visit. Propensity score matching (1:5) was used to match patients with and without a CT-first strategy. After matching, 12 545 patients were included of which 2308 CT-first patients and 10 237 patients that underwent usual care.

RESULTS: Mean age was 57 years, 56.3% were women and median follow-up was 4.9 years. All-cause mortality was significantly lower in CT-first patients (n=43, 1.9%) compared with patients without CT (n=363, 3.5%) (HR: 0.51, 95% CI 0.37 to 0.70). Furthermore, CT-first patients were more likely to receive cardiovascular preventative and antianginal medication (aspirin: 44.9% vs 27.1%, statins: 48.7% vs 30.3%, beta-blockers: 37.8% vs 25.5%, in CT-first and without CT-first patients, respectively) and to undergo downstream diagnostics and interventions (coronary interventions: 8.5% vs 5.7%, coronary angiography: 16.2% vs 10.6% in CT-first and without CT-first patients, respectively).

CONCLUSIONS: In a real-world regular care database, a CT-first strategy in patients suspected of angina pectoris was associated with a lowering of all-cause mortality.

Original languageEnglish
Article numberheartjnl-2021-319747
Pages (from-to)1361-1368
Number of pages8
Issue number17
Early online date15 Nov 2021
Publication statusPublished - 11 Aug 2022


  • computed tomography angiography
  • coronary artery disease
  • diagnostic imaging
  • electronic health records


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