Table 3.

Focus topic: contemporary multicentre strategy trials of cardiac imaging in patients with suspected stable IHD

Title	Design	Result
Published trials
PROMISE  NCT01174550	Aim: To compare CTCA versus standard care functional assessment Setting: Hospitals in the USA Sample size: 10 003 Primary endpoint: Death, MI, unstable angina	Compared with noninvasive functional testing, an initial strategy of CTCA did not improve clinical outcomes at a median follow-up of 2 years (primary endpoint event of 3.3% in the CTCA versus 3.0% in the noninvasive functional testing group)
SCOT-HEART  NCT01149590	Aim: Comparison of usual care to CTCA Setting: Chest pain and cardiology clinics in hospitals in Scotland Sample size: 4146 Primary endpoint: Death from coronary heart disease or nonfatal myocardial infarction at 5 years	Th primary endpoint was lower in the CTA group than in the standard care group (2.3% [48 patients] vs 3.9% (81 patients); HR, 0.59; 95% CI, 0.41 to 0.84; p=0.004
CE-MARC2  NCT01664858	Aim: To assess whether unnecessary invasive coronary angiograms are reduced using stress perfusion CMR at 3.0 Tesla versus MPS versus NICE guideline-directed care Setting: Chest pain and cardiology clinics in hospitals in the UK Sample size: 1202 Primary endpoint: Unnecessary invasive coronary angiography occurring within 12 months in each arm	The primary outcome occurred in 69 (28.8%) in the NICE guideline-directed group, and 36 (7.5%) and 34 (7.1%) in the CMR and MPS groups, respectively. There was a statistically significant lower adjusted OR of unnecessary angiography in the CMR versus NICE guideline-directed group (0.21, p<0.001), with no difference between the CMR or MPS group (1.27, p=0.32)
Trials yet to publish
ISCHEMIA  NCT01471522	Aim: To assess whether or not an initial invasive strategy of invasive angiography and optimal revascularisation if feasible, in addition to OMT in patients with stable CAD and at least moderate ischaemia on noninvasive ischaemia improves health outcomes compared with OMT alone Setting: Hospitals worldwide Sample size: 8000	Time to first occurrence of cardiovascular death or nonfatal myocardial infarction
DISCHARGE  NCT02400229	Aim: To evaluate whether CTCA-based management over invasive coronary angiography-guided care is superior in patients with stable angina and an intermediate pretest probability (10%–60%) of CAD Setting: Hospitals in Europe Sample size: 3546	Cardiovascular death, nonfatal myocardial infarction and nonfatal stroke at a maximum follow-up of 4 years.
FORECAST  NCT03187639	Aim: To assess whether routine FFR-CT is superior, in terms of resource utilisation, when compared with routine clinical pathway algorithms recommended by NICE Setting: Single centre in the UK Sample size: 1400	Resource utilisation at 9 months.
MR-INFORM  NCT01236807	Aim: To assess whether or not stress perfusion CMR is noninferior to invasive coronary angiography and FFR measurement for the management of patients with angina Setting: Hospitals in the UK, Europe and Australia Sample size: 918	Death, myocardial infarction and repeat coronary revascularisation at 1 year
CorCTCA  NCT03477890	Aim: To assess the prevalence of microvascular or vasospastic angina and the impact of invasive coronary artery function tests, in patients with nonobstructive CAD Setting: Three hospitals in the UK Sample size: 250	The between-group difference in the reclassification rate of the initial diagnosis following disclosure of invasive coronary artery function tests

CAD, coronary artery disease;CE-MARC2, Clinical Evaluation of Magnetic Resonance Imaging in Coronary heart disease 2; CMR, Cardiac Magnetic Resonance; CTCA, CT coronary angiography;FFR, fractional flow reserve;IHD, ischaemic heart disease; MI, myocardial infarction;MPS, myocardial perfusion scintigraphy; NICE, National Institute of Health and Care Excellence; OMT, optimised medical therapy; PROMISE, progesterone in recurrent miscarriage; SCOT-HEART, Scottish COmputed Tomography of the HEART.