JAMA Cardiol; 2019 Nov 18; EPub Ahead of Print; A Lowenstern, KP Alexander, CL Hill, et al
This study assessed whether the predictive usefulness of anatomic versus functional testing varies based on patient age. The PROMISE study enrolled outpatients without known CAD but with symptoms suggesting CAD from 193 sites across North America. Participants were randomized to functional testing (4466) or coronary CTA (4500). Participants were stratified into three groups by age: <65 years, 65 to 74 years, or >75 years. The primary outcome was the composite of CV death and MI over a median follow-up of 25 months. Results showed that a positive functional test was associated with CV death/MI among older patients but not in patients younger than 65 years. A positive coronary CTA test (showing obstructive CAD with ≥70% stenosis or ≥50% left main stenosis) was associated with CV death/MI among patients younger than 65 years but not among older patients. An elevated coronary artery calcium score (>100) was predictive of events in patients younger than 65 years but not in older patients.