Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2

Colin Everett; Colin Berry; Gerry P McCann; Catherine Fernandez; Catherine Reynolds; Chiara Bucciarelli-Ducci; Erica Dall’Armellina; Abhiram Prasad; James Foley; Kenneth Mangion; Petra Bijsterveld; Julia Brown; Deborah Stocken; Simon Walker; Mark Sculpher; Sven Plein; John Greenwood

doi:10.1136/openhrt-2022-002221

Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2

Colin Everett, Colin Berry, Gerry P McCann, Catherine Fernandez, Catherine Reynolds, Chiara Bucciarelli-Ducci, Erica Dall’Armellina, Abhiram Prasad, James Foley, Kenneth Mangion, Petra Bijsterveld, Julia Brown, Deborah Stocken, Simon Walker, Mark Sculpher, Sven Plein, John Greenwood

Division of Population Health, Health Services Research & Primary Care (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

Aims Guidelines for suspected cardiac chest pain have used historical risk stratification tools, advocating invasive coronary angiography (ICA) first-line in those at highest risk. We aimed to determine whether different strategies to manage suspected stable angina affected medium-term cardiovascular event rates and patient-reported quality of life (QoL) measures.

Methods CE-MARC 2, a three-arm parallel group trial, randomised patients with suspected stable cardiac chest pain and a Duke Clinical pretest likelihood of coronary artery disease between 10% and 90%. Patients were randomised to either first-line cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT) or the UK National Institute for Health and Care Excellence (NICE) CG95 (2010) guidelines-directed care. For the three arms, 1-year and 3-year first major adverse cardiovascular event (MACE) rates and QoL assessed by the Seattle Angina Questionnaire, Short Form 12 (V.12) Questionnaire and EuroQol-5 Dimension Questionnaire were recorded.

Results 1202 patients were randomised to CMR (n=481), SPECT (n=481) and NICE (n=240). Forty-two patients (18 CMR, 18 SPECT, 6 NICE) experienced one or more MACEs. The percentage rates (95% CIs) of MACE in the CMR, SPECT and NICE groups at 3 years were 3.7% (2.4%, 5.8%), 3.7% (2.4%, 5.8%) and 2.1% (0.9%, 4.8%), respectively. QoL scores did not significantly differ across domains.

Conclusion Despite a fourfold increase in referrals for ICA, the NICE CG95 (2010) guidelines risk-stratified care strategy did not significantly reduce 3-year MACE or improve QoL, as compared with functional imaging with CMR or SPECT.

Trial registration number ClinicalTrials.gov Registry (NCT01664858).

Original language	English
Article number	e002221
Journal	Open Heart
Volume	10
DOIs	https://doi.org/10.1136/openhrt-2022-002221
Publication status	Published - 2 May 2023

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Everett, C., Berry, C., McCann, G. P., Fernandez, C., Reynolds, C., Bucciarelli-Ducci, C., Dall’Armellina, E., Prasad, A., Foley, J., Mangion, K., Bijsterveld, P., Brown, J., Stocken, D., Walker, S., Sculpher, M., Plein, S., & Greenwood, J. (2023). Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2. Open Heart, 10, Article e002221. https://doi.org/10.1136/openhrt-2022-002221

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title = "Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2",

abstract = "Aims Guidelines for suspected cardiac chest pain have used historical risk stratification tools, advocating invasive coronary angiography (ICA) first-line in those at highest risk. We aimed to determine whether different strategies to manage suspected stable angina affected medium-term cardiovascular event rates and patient-reported quality of life (QoL) measures.Methods CE-MARC 2, a three-arm parallel group trial, randomised patients with suspected stable cardiac chest pain and a Duke Clinical pretest likelihood of coronary artery disease between 10% and 90%. Patients were randomised to either first-line cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT) or the UK National Institute for Health and Care Excellence (NICE) CG95 (2010) guidelines-directed care. For the three arms, 1-year and 3-year first major adverse cardiovascular event (MACE) rates and QoL assessed by the Seattle Angina Questionnaire, Short Form 12 (V.12) Questionnaire and EuroQol-5 Dimension Questionnaire were recorded.Results 1202 patients were randomised to CMR (n=481), SPECT (n=481) and NICE (n=240). Forty-two patients (18 CMR, 18 SPECT, 6 NICE) experienced one or more MACEs. The percentage rates (95% CIs) of MACE in the CMR, SPECT and NICE groups at 3 years were 3.7% (2.4%, 5.8%), 3.7% (2.4%, 5.8%) and 2.1% (0.9%, 4.8%), respectively. QoL scores did not significantly differ across domains.Conclusion Despite a fourfold increase in referrals for ICA, the NICE CG95 (2010) guidelines risk-stratified care strategy did not significantly reduce 3-year MACE or improve QoL, as compared with functional imaging with CMR or SPECT.Trial registration number ClinicalTrials.gov Registry (NCT01664858).",

author = "Colin Everett and Colin Berry and McCann, {Gerry P} and Catherine Fernandez and Catherine Reynolds and Chiara Bucciarelli-Ducci and Erica Dall{\textquoteright}Armellina and Abhiram Prasad and James Foley and Kenneth Mangion and Petra Bijsterveld and Julia Brown and Deborah Stocken and Simon Walker and Mark Sculpher and Sven Plein and John Greenwood",

year = "2023",

month = may,

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doi = "10.1136/openhrt-2022-002221",

language = "English",

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journal = "Open Heart",

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Everett, C, Berry, C, McCann, GP, Fernandez, C, Reynolds, C, Bucciarelli-Ducci, C, Dall’Armellina, E, Prasad, A, Foley, J, Mangion, K, Bijsterveld, P, Brown, J, Stocken, D, Walker, S, Sculpher, M, Plein, S & Greenwood, J 2023, 'Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2', Open Heart, vol. 10, e002221. https://doi.org/10.1136/openhrt-2022-002221

TY - JOUR

T1 - Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2

AU - Everett, Colin

AU - Berry, Colin

AU - McCann, Gerry P

AU - Fernandez, Catherine

AU - Reynolds, Catherine

AU - Bucciarelli-Ducci, Chiara

AU - Dall’Armellina, Erica

AU - Prasad, Abhiram

AU - Foley, James

AU - Mangion, Kenneth

AU - Bijsterveld, Petra

AU - Brown, Julia

AU - Stocken, Deborah

AU - Walker, Simon

AU - Sculpher, Mark

AU - Plein, Sven

AU - Greenwood, John

PY - 2023/5/2

Y1 - 2023/5/2

N2 - Aims Guidelines for suspected cardiac chest pain have used historical risk stratification tools, advocating invasive coronary angiography (ICA) first-line in those at highest risk. We aimed to determine whether different strategies to manage suspected stable angina affected medium-term cardiovascular event rates and patient-reported quality of life (QoL) measures.Methods CE-MARC 2, a three-arm parallel group trial, randomised patients with suspected stable cardiac chest pain and a Duke Clinical pretest likelihood of coronary artery disease between 10% and 90%. Patients were randomised to either first-line cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT) or the UK National Institute for Health and Care Excellence (NICE) CG95 (2010) guidelines-directed care. For the three arms, 1-year and 3-year first major adverse cardiovascular event (MACE) rates and QoL assessed by the Seattle Angina Questionnaire, Short Form 12 (V.12) Questionnaire and EuroQol-5 Dimension Questionnaire were recorded.Results 1202 patients were randomised to CMR (n=481), SPECT (n=481) and NICE (n=240). Forty-two patients (18 CMR, 18 SPECT, 6 NICE) experienced one or more MACEs. The percentage rates (95% CIs) of MACE in the CMR, SPECT and NICE groups at 3 years were 3.7% (2.4%, 5.8%), 3.7% (2.4%, 5.8%) and 2.1% (0.9%, 4.8%), respectively. QoL scores did not significantly differ across domains.Conclusion Despite a fourfold increase in referrals for ICA, the NICE CG95 (2010) guidelines risk-stratified care strategy did not significantly reduce 3-year MACE or improve QoL, as compared with functional imaging with CMR or SPECT.Trial registration number ClinicalTrials.gov Registry (NCT01664858).

AB - Aims Guidelines for suspected cardiac chest pain have used historical risk stratification tools, advocating invasive coronary angiography (ICA) first-line in those at highest risk. We aimed to determine whether different strategies to manage suspected stable angina affected medium-term cardiovascular event rates and patient-reported quality of life (QoL) measures.Methods CE-MARC 2, a three-arm parallel group trial, randomised patients with suspected stable cardiac chest pain and a Duke Clinical pretest likelihood of coronary artery disease between 10% and 90%. Patients were randomised to either first-line cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT) or the UK National Institute for Health and Care Excellence (NICE) CG95 (2010) guidelines-directed care. For the three arms, 1-year and 3-year first major adverse cardiovascular event (MACE) rates and QoL assessed by the Seattle Angina Questionnaire, Short Form 12 (V.12) Questionnaire and EuroQol-5 Dimension Questionnaire were recorded.Results 1202 patients were randomised to CMR (n=481), SPECT (n=481) and NICE (n=240). Forty-two patients (18 CMR, 18 SPECT, 6 NICE) experienced one or more MACEs. The percentage rates (95% CIs) of MACE in the CMR, SPECT and NICE groups at 3 years were 3.7% (2.4%, 5.8%), 3.7% (2.4%, 5.8%) and 2.1% (0.9%, 4.8%), respectively. QoL scores did not significantly differ across domains.Conclusion Despite a fourfold increase in referrals for ICA, the NICE CG95 (2010) guidelines risk-stratified care strategy did not significantly reduce 3-year MACE or improve QoL, as compared with functional imaging with CMR or SPECT.Trial registration number ClinicalTrials.gov Registry (NCT01664858).

U2 - 10.1136/openhrt-2022-002221

DO - 10.1136/openhrt-2022-002221

M3 - Article

SN - 2053-3624

VL - 10

JO - Open Heart

JF - Open Heart

M1 - e002221

ER -

Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2

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