Trial Outcomes & Findings for Randomized Evaluation of Patients With Stable Angina Comparing Diagnostic Examinations (NCT NCT01262625)

NCT ID: NCT01262625

Last Updated: 2023-12-26

Results Overview

To compare outcomes of participants with symptoms of stable angina or angina equivalent evaluated with an anatomic imaging strategy using CCTA as initial method of computer-aided diagnosis (CAD) (Group A) to a combined functional and anatomic imaging strategy of SPECT MPI/ICA (Group B) as a guide to Optimal Medical Therapy (OMT) alone. The analysis was conducted from an intent-to-treat perspective

Recruitment status

TERMINATED

Study phase

NA

Target enrollment

1050 participants

Primary outcome timeframe

up to 24 Months (depends on time of trial enrollment and funding duration)

Results posted on

2023-12-26

Participant Flow

The study opened to enrollment in May 2011 and was closed to enrollment in June 2013 due to resource limitations. The study was designed to enroll and randomize 4300 participants to the 2 study arms, but given the difficulties of recruiting enough patients to fulfill the stringent entry criteria, as well as time constraints for funding (American Recovery and Reinvestment Act award, 3-year cap), only one quarter of the planned sample size could be recruited .

Participant milestones

Participant milestones
Measure
Group A: CCTA Diagnostic
Participants randomized to diagnostic evaluation using coronary computed tomographic angiography (CCTA) to determine therapeutic course of action. CCTA: Complete diagnostic CCTA per protocol specifications.
Group B: SPECT MPI/ICA Diagnostic
Standard-of-care diagnostic assessment using single photon emission computed tomography myocardial perfusion imaging (SPECT MPI), possibly followed by diagnostic invasive coronary angiography (ICA) dependent on SPECT MPI results. SPECT MPI/ICA: Perform SPECT MPI per institutional standard practice; diagnostic ICA will be performed only as indicated per protocol.
Overall Study
STARTED
518
532
Overall Study
Scan Available
475
465
Overall Study
Uninterpretable Scan
6
4
Overall Study
COMPLETED
516
531
Overall Study
NOT COMPLETED
2
1

Reasons for withdrawal

Reasons for withdrawal
Measure
Group A: CCTA Diagnostic
Participants randomized to diagnostic evaluation using coronary computed tomographic angiography (CCTA) to determine therapeutic course of action. CCTA: Complete diagnostic CCTA per protocol specifications.
Group B: SPECT MPI/ICA Diagnostic
Standard-of-care diagnostic assessment using single photon emission computed tomography myocardial perfusion imaging (SPECT MPI), possibly followed by diagnostic invasive coronary angiography (ICA) dependent on SPECT MPI results. SPECT MPI/ICA: Perform SPECT MPI per institutional standard practice; diagnostic ICA will be performed only as indicated per protocol.
Overall Study
Administrative Error
1
1
Overall Study
Site Closed
1
0

Baseline Characteristics

Randomized Evaluation of Patients With Stable Angina Comparing Diagnostic Examinations

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Group A: CCTA Diagnostic
n=516 Participants
Participants randomized to diagnostic evaluation using CCTA to determine therapeutic course of action. CCTA: Complete diagnostic CCTA per protocol specifications.
Group B: SPECT MPI/ICA Diagnostic
n=531 Participants
Standard-of-care diagnostic assessment using SPECT MPI, possibly followed by diagnostic ICA dependent on SPECT MPI results. SPECT MPI/ICA: Perform SPECT MPI per institutional standard practice; diagnostic ICA will be performed only as indicated per protocol.
Total
n=1047 Participants
Total of all reporting groups
Age, Continuous
57 years
STANDARD_DEVIATION 9 • n=93 Participants
58 years
STANDARD_DEVIATION 9 • n=4 Participants
58 years
STANDARD_DEVIATION 9 • n=27 Participants
Sex: Female, Male
Female
233 Participants
n=93 Participants
244 Participants
n=4 Participants
477 Participants
n=27 Participants
Sex: Female, Male
Male
283 Participants
n=93 Participants
287 Participants
n=4 Participants
570 Participants
n=27 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
46 Participants
n=93 Participants
58 Participants
n=4 Participants
104 Participants
n=27 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
467 Participants
n=93 Participants
468 Participants
n=4 Participants
935 Participants
n=27 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
3 Participants
n=93 Participants
5 Participants
n=4 Participants
8 Participants
n=27 Participants
Race (NIH/OMB)
American Indian or Alaska Native
8 Participants
n=93 Participants
7 Participants
n=4 Participants
15 Participants
n=27 Participants
Race (NIH/OMB)
Asian
11 Participants
n=93 Participants
14 Participants
n=4 Participants
25 Participants
n=27 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
2 Participants
n=93 Participants
1 Participants
n=4 Participants
3 Participants
n=27 Participants
Race (NIH/OMB)
Black or African American
73 Participants
n=93 Participants
77 Participants
n=4 Participants
150 Participants
n=27 Participants
Race (NIH/OMB)
White
400 Participants
n=93 Participants
415 Participants
n=4 Participants
815 Participants
n=27 Participants
Race (NIH/OMB)
More than one race
10 Participants
n=93 Participants
5 Participants
n=4 Participants
15 Participants
n=27 Participants
Race (NIH/OMB)
Unknown or Not Reported
12 Participants
n=93 Participants
12 Participants
n=4 Participants
24 Participants
n=27 Participants

PRIMARY outcome

Timeframe: up to 24 Months (depends on time of trial enrollment and funding duration)

To compare outcomes of participants with symptoms of stable angina or angina equivalent evaluated with an anatomic imaging strategy using CCTA as initial method of computer-aided diagnosis (CAD) (Group A) to a combined functional and anatomic imaging strategy of SPECT MPI/ICA (Group B) as a guide to Optimal Medical Therapy (OMT) alone. The analysis was conducted from an intent-to-treat perspective

Outcome measures

Outcome measures
Measure
Group A: CCTA Diagnostic
n=516 Participants
Participants randomized to diagnostic evaluation using CCTA to determine therapeutic course of action. CCTA: Complete diagnostic CCTA per protocol specifications.
Group B: SPECT MPI/ICA Diagnostic
n=531 Participants
Standard-of-care diagnostic assessment using SPECT MPI, possibly followed by diagnostic ICA dependent on SPECT MPI results. SPECT MPI/ICA: Perform SPECT MPI per institutional standard practice; diagnostic ICA will be performed only as indicated per protocol.
Group A: CCTA + AHA 16 + Clinical Data Predictor
A new predictive model based upon the raw CCTA stenosis data using the AHA 16-segments: graded as normal (0%), very mild (1-29%), mild (30-49%), moderate (50-69%), or severe (≥70%) stenosis for Group A CCTA Participants. Because of the relatively few MACE events, these were grouped to \<30%, 30-49%, and ≥50% for subsequent analysis. Hypertension was included in the model as the only clinical risk factor selected by multivariate modeling.
Group B: SPECT % Reversible Defect Size
Standard-of-care (SOC) diagnostic assessment using SPECT MPI (Group B) % Reversible defect size calculated as per institutional SOC.
Time-dependent Rates of the Composite Primary Endpoint Major Adverse Cardiovascular Event (MACE: Comprising Cardiac-related Death or Acute Myocardial Infarction (AMI), and Revascularization)
No Event
487 Participants
504 Participants
Time-dependent Rates of the Composite Primary Endpoint Major Adverse Cardiovascular Event (MACE: Comprising Cardiac-related Death or Acute Myocardial Infarction (AMI), and Revascularization)
Event Occurred
29 Participants
27 Participants

SECONDARY outcome

Timeframe: 1 year

Population: For the secondary analyses, patients with \<1-year follow-up (defined as \<335 days) were excluded from analysis, as were ineligible patients and patients without the respective randomized scan or with an uninterpretable scan The analysis will compare the the proposed SPECT % reversible defect size vs the a modified Duke Score and the standard CCTA +AHA 16 to predict MACE events.

AUC is a unitless measure of performance ranging form 0.5 (guessing) to 1.0 (perfect predictor) that can be thought of a the proportion of correct classifications in a 2-alternative-forced-choice experiment - and for binary outcomes, it is equivalent to the C-statistic. It will be used to evaluate and compare the ability of available prognostic indices and SPECT-MPI % reversible defect size to predict revascularization or MACE using CCTA information: A CCTA Modified Duke index A CCTA index including the 16 individual American Heart Association (AHA) segments A CCTA including the 16 individual AHA segments and clinical data and compare them to the SPECT % reversible defect size results

Outcome measures

Outcome measures
Measure
Group A: CCTA Diagnostic
n=401 Participants
Participants randomized to diagnostic evaluation using CCTA to determine therapeutic course of action. CCTA: Complete diagnostic CCTA per protocol specifications.
Group B: SPECT MPI/ICA Diagnostic
n=401 Participants
Standard-of-care diagnostic assessment using SPECT MPI, possibly followed by diagnostic ICA dependent on SPECT MPI results. SPECT MPI/ICA: Perform SPECT MPI per institutional standard practice; diagnostic ICA will be performed only as indicated per protocol.
Group A: CCTA + AHA 16 + Clinical Data Predictor
n=401 Participants
A new predictive model based upon the raw CCTA stenosis data using the AHA 16-segments: graded as normal (0%), very mild (1-29%), mild (30-49%), moderate (50-69%), or severe (≥70%) stenosis for Group A CCTA Participants. Because of the relatively few MACE events, these were grouped to \<30%, 30-49%, and ≥50% for subsequent analysis. Hypertension was included in the model as the only clinical risk factor selected by multivariate modeling.
Group B: SPECT % Reversible Defect Size
n=378 Participants
Standard-of-care (SOC) diagnostic assessment using SPECT MPI (Group B) % Reversible defect size calculated as per institutional SOC.
Prediction of Response (MACE/Revascularization) at 1 Year Using: Modified Duke Score or CCTA + AHA 16 Predictor/CCTA+AHA 16+Clinical Data Predictor or SPECT% Reversible Defect Size Reported as Receiver Operating Characteristic (ROC) Area Under Curve (AUC)
0.87 unitless
Interval 0.81 to 0.94
0.92 unitless
Interval 0.87 to 0.96
0.93 unitless
Interval 0.89 to 0.97
0.73 unitless
Interval 0.59 to 0.88

SECONDARY outcome

Timeframe: baseline and 12 months

Population: Only cases with and an available screen result and both baseline and 1-year surveys completed are included in this analysis

SF36+SAQ at baseline and to a subset of participants, stratified by diagnostic examination, at 12 months after enrollment to monitor angina symptoms and their impact on Quality of life. The Short Form-36 (SF36) is a 36 item overall health status/Quality of Life collected in 8 domains. Scales are standardized with scores ranging from 0-100. Higher scores= better health status. The Seattle Angina Questionnaire (SAQ) is a self-administered, 19-item, cardiac disease-related quality-of-life measure collected in 5 domains. scales are standardized with scores ranging from 0-100. Higher scores= better health status. Positive cardiac findings on diagnostic testing are defined as: 1. 50% stenosis on CCTA or un-evaluable left main, or proximal and mid segments of all other epicardial arteries (right coronary artery, left anterior descending artery, or left circumflex artery); and 2. 10% reversible defect on SPECT MPI or evidence of Transient Ischemic Dilation (TID) accompanied by ECG

Outcome measures

Outcome measures
Measure
Group A: CCTA Diagnostic
n=132 Participants
Participants randomized to diagnostic evaluation using CCTA to determine therapeutic course of action. CCTA: Complete diagnostic CCTA per protocol specifications.
Group B: SPECT MPI/ICA Diagnostic
n=155 Participants
Standard-of-care diagnostic assessment using SPECT MPI, possibly followed by diagnostic ICA dependent on SPECT MPI results. SPECT MPI/ICA: Perform SPECT MPI per institutional standard practice; diagnostic ICA will be performed only as indicated per protocol.
Group A: CCTA + AHA 16 + Clinical Data Predictor
n=42 Participants
A new predictive model based upon the raw CCTA stenosis data using the AHA 16-segments: graded as normal (0%), very mild (1-29%), mild (30-49%), moderate (50-69%), or severe (≥70%) stenosis for Group A CCTA Participants. Because of the relatively few MACE events, these were grouped to \<30%, 30-49%, and ≥50% for subsequent analysis. Hypertension was included in the model as the only clinical risk factor selected by multivariate modeling.
Group B: SPECT % Reversible Defect Size
n=10 Participants
Standard-of-care (SOC) diagnostic assessment using SPECT MPI (Group B) % Reversible defect size calculated as per institutional SOC.
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Role emotional: Baseline
47.9 score on a scale
Standard Deviation 12.07
48.08 score on a scale
Standard Deviation 11.12
44.96 score on a scale
Standard Deviation 10.16
48.51 score on a scale
Standard Deviation 9.77
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Mental health: Baseline
49.98 score on a scale
Standard Deviation 10.16
48.51 score on a scale
Standard Deviation 9.77
47.83 score on a scale
Standard Deviation 9.36
50.01 score on a scale
Standard Deviation 7.39
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Physical limitation: Baseline
67.50 score on a scale
Standard Deviation 15.83
67.12 score on a scale
Standard Deviation 17.20
65.20 score on a scale
Standard Deviation 16.67
67.41 score on a scale
Standard Deviation 17.36
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Angina stability: Baseline
44.34 score on a scale
Standard Deviation 31.42
48.87 score on a scale
Standard Deviation 32.71
40.98 score on a scale
Standard Deviation 30.32
38.00 score on a scale
Standard Deviation 27.41
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Angina frequency: Baseline
77.38 score on a scale
Standard Deviation 15.24
79.79 score on a scale
Standard Deviation 15.40
74.25 score on a scale
Standard Deviation 16.15
75.00 score on a scale
Standard Deviation 15.81
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Treatment satisfaction: Baseline
84.64 score on a scale
Standard Deviation 15.57
85.87 score on a scale
Standard Deviation 15.95
85.85 score on a scale
Standard Deviation 15.41
82.94 score on a scale
Standard Deviation 11.91
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Disease perception: Baseline
58.74 score on a scale
Standard Deviation 20.18
59.33 score on a scale
Standard Deviation 19.81
54.38 score on a scale
Standard Deviation 19.06
62.50 score on a scale
Standard Deviation 19.74
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Physical component: 1-Year
47.44 score on a scale
Standard Deviation 10.66
46.39 score on a scale
Standard Deviation 10.4
47.27 score on a scale
Standard Deviation 8.66
52.51 score on a scale
Standard Deviation 5.04
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Physical functioning: 1-Year
46.96 score on a scale
Standard Deviation 10.77
47.35 score on a scale
Standard Deviation 10.46
46.56 score on a scale
Standard Deviation 9.31
51.77 score on a scale
Standard Deviation 5.97
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Role-physical: 1-Year
48.14 score on a scale
Standard Deviation 11.28
46.00 score on a scale
Standard Deviation 11.07
48.38 score on a scale
Standard Deviation 9.20
53.42 score on a scale
Standard Deviation 4.65
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Bodily pain: 1-Year
47.96 score on a scale
Standard Deviation 10.15
46.62 score on a scale
Standard Deviation 10.16
45.91 score on a scale
Standard Deviation 10.13
53.03 score on a scale
Standard Deviation 7.14
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: General health: 1-Year
49.10 score on a scale
Standard Deviation 10.74
46.40 score on a scale
Standard Deviation 10.86
46.84 score on a scale
Standard Deviation 9.84
53.55 score on a scale
Standard Deviation 7.64
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Mental comp: 1-Year
50.11 score on a scale
Standard Deviation 10.82
48.11 score on a scale
Standard Deviation 10.96
46.69 score on a scale
Standard Deviation 11.50
53.51 score on a scale
Standard Deviation 6.93
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Vitality: 1-Year
50.09 score on a scale
Standard Deviation 40.51
47.78 score on a scale
Standard Deviation 11.49
48.72 score on a scale
Standard Deviation 11.15
53.96 score on a scale
Standard Deviation 6.45
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Social functioning: 1-Year
48.72 score on a scale
Standard Deviation 11.15
53.96 score on a scale
Standard Deviation 6.45
48.54 score on a scale
Standard Deviation 10.77
46.72 score on a scale
Standard Deviation 11.21
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Role emotional: 1-Year
48.43 score on a scale
Standard Deviation 11.07
46.89 score on a scale
Standard Deviation 11.59
46.25 score on a scale
Standard Deviation 9.84
52.38 score on a scale
Standard Deviation 7.87
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Mental health: 1-Year
50.17 score on a scale
Standard Deviation 10.24
48.26 score on a scale
Standard Deviation 10.38
46.45 score on a scale
Standard Deviation 11.58
54.23 score on a scale
Standard Deviation 6.40
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Physical limitation: 1-Year
71.98 score on a scale
Standard Deviation 16.65
68.80 score on a scale
Standard Deviation 17.83
66.61 score on a scale
Standard Deviation 17.39
76.30 score on a scale
Standard Deviation 10.77
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Angina stability: 1-Year
80.31 score on a scale
Standard Deviation 28.17
82.52 score on a scale
Standard Deviation 27.26
71.71 score on a scale
Standard Deviation 30.98
92.00 score on a scale
Standard Deviation 19.32
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Angina frequency: 1-Year
92.46 score on a scale
Standard Deviation 11.36
92.59 score on a scale
Standard Deviation 14.71
86.00 score on a scale
Standard Deviation 16.46
97.00 score on a scale
Standard Deviation 6.75
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Treatment satisfaction: 1-Year
87.40 score on a scale
Standard Deviation 17.89
86.85 score on a scale
Standard Deviation 20.74
84.90 score on a scale
Standard Deviation 18.42
97.65 score on a scale
Standard Deviation 3.04
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SAQ: Disease perception: 1-Year
79.03 score on a scale
Standard Deviation 20.16
77.58 score on a scale
Standard Deviation 21.77
71.04 score on a scale
Standard Deviation 23.64
91.67 score on a scale
Standard Deviation 13.61
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF-36: Phys comp: Baseline
45.41 score on a scale
Standard Deviation 9.27
46.07 score on a scale
Standard Deviation 9.69
46.10 score on a scale
Standard Deviation 8.51
47.2 score on a scale
Standard Deviation 9.19
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF-36: Phys Func: Baseline
46.41 score on a scale
Standard Deviation 10.48
47.16 score on a scale
Standard Deviation 9.98
46.4 score on a scale
Standard Deviation 9361
46.3 score on a scale
Standard Deviation 12.37
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF-36: Role-physical: Baseline
46.07 score on a scale
Standard Deviation 10.22
46.76 score on a scale
Standard Deviation 10.26
45.77 score on a scale
Standard Deviation 8.79
48.04 score on a scale
Standard Deviation 10.07
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Bodily pain: Baseline
45.83 score on a scale
Standard Deviation 9.11
45.87 score on a scale
Standard Deviation 8.72
46.31 score on a scale
Standard Deviation 7.94
45.55 score on a scale
Standard Deviation 9.65
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: General health: Baseline
47.10 score on a scale
Standard Deviation 9.01
46.43 score on a scale
Standard Deviation 9.51
46.17 score on a scale
Standard Deviation 8.13
50.31 score on a scale
Standard Deviation 5.08
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Mental comp: Baseline
49.42 score on a scale
Standard Deviation 11.15
48.52 score on a scale
Standard Deviation 10.64
47.09 score on a scale
Standard Deviation 9.55
49.46 score on a scale
Standard Deviation 6.91
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Vitality: Baseline
48.11 score on a scale
Standard Deviation 10.23
46.75 score on a scale
Standard Deviation 10.9
47.9 score on a scale
Standard Deviation 9.86
46.75 score on a scale
Standard Deviation 10.90
Short Form-36 Survey (SF-36v2) and Seattle Angina Questionnaire (SAQ) Score
SF36: Social functioning: Baseline
46.60 score on a scale
Standard Deviation 10.63
47.25 score on a scale
Standard Deviation 10.42
46.86 score on a scale
Standard Deviation 9.40
49.76 score on a scale
Standard Deviation 5.17

SECONDARY outcome

Timeframe: Baseline and 1 year

Population: The study was terminated before data to compute life years was collected SF-36 scores have been reported previously

International medical records will be used to determine mortality which may not be feasible at all participating international sites. Utilities will be based on Quality of Well Being scores converted from the SF-36 assessments The analysis will be performed assuming a societal perspective and lifetime time horizon

Outcome measures

Outcome data not reported

Adverse Events

Group A: CCTA Diagnostic

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Group B: SPECT MPI/ICA Diagnostic

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Director Clinical Research Administration

American College of Radiology

Phone: 215-574-3150

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place