PROMISE Cinical Trial

PROMISE Clinical Trial (“A Randomized Comparison of Anatomic versus Functional Diagnostic Testing Strategies in Symptomatic Patients with Suspected Coronary Artery Disease”), Presented at the ACC Scientific Sessions

SAN DIEGO (March 14, 2015) – Today at the American College of Cardiology (ACC) Annual Scientific Sessions in San Diego, results from the keenly anticipated PROMISE clinical trial confirmed what many cardiologists and radiologists have long suspected to be true: coronary computed tomographic angiography (coronary CTA) is extraordinarily effective in accurately diagnosing patients with low to moderate chest pain.  In most cases, coronary CTA is at least as effective as diagnostic methods such as stress tests such as SPECT myocardial perfusion imaging.

SCCT President Ricardo C. Cury, MD, FSCCT (Miami) observed that these findings demonstrate that coronary CTA plays a critical role in enabling physicians to determine and plan the best course of action in treating the millions of persons annually who present with low to moderate chest pain.  Dr. Cury noted that “Today’s findings from PROMISE show that coronary CTA is a viable alternative to functional stress testing to assess symptomatic, intermediate risk patients for whom testing is currently recommended.  As a matter of fact, an initial strategy with CTA was associated with a significant lower rate of invasive catheterization without obstructive CAD (28%) as compared to a functional strategy with stress test that demonstrated 52% of invasive catheterization without obstructive CAD. This study should significantly impact daily clinical practice, with the potential to dramatically reduce the number of unnecessary invasive angiograms, stress tests and other resource-intensive procedures.”      

President-Elect Jonathon A. Leipsic, MD, FSCCT (Vancouver) added that the impact of this study may go well beyond initial evaluation of the presenting patient, by helping physicians recommend the most appropriate long-term care for their patients.   “These results are very exciting,” Dr. Leipsic stressed.  “PROMISE affirms our experience in clinical practice, notably the apparent benefit of medical therapy on those uniquely identified by coronary CTA to have non-obstructive atherosclerosis.  PROMISE appears to demonstrate that coronary CTA uniquely identifies a patients who have non-obstructive atherosclerosis and who will benefit from medical therapy.  Interestingly, there was also a significant early benefit of the CTA strategy over functional imaging for decreasing hard events (death or non-fatal MI) in 12 months. This is extremely impactful data.”  

Coronary CTA is an imaging method that uses a computed tomography (CT) scanner to non-invasively and painlessly examine the structure and blood vessels of the heart.  While this technology has been in use for many years elsewhere in the body, recent advances in CT scanners now enable highly trained physicians and technologists to take and interpret three-dimensional images of the beating heart with extraordinary clarity and detail.  With these recent advances, a coronary CTA now can replace the need for an exercise stress test or an invasive cardiac catheterization and angiogram. 

Commenting on the PROMISE trial’s potential impact on everyday medical practice, SCCT Vice President, Leslee J. Shaw, Ph.D (Atlanta) emphasized that “this is a very large and rigorously performed randomized trial comparing coronary CTA to functional testing. Although this is relatively new when compared to stress testing, results from PROMISE are very compelling and support expanded use of noninvasive CT angiography for evaluation of patients with stable chest pain. Clearly, the findings support expanded use of coronary CTA as an equally effective and safe procedure for patients presenting with suspected heart disease.”