Deferred Testing in Stable Outpatients With Suspected Coronary Artery Disease: A Prespecified Secondary Analysis of the PRECISE Randomized Clinical Trial
Primary resultResult — go to the resultHazard ratio 0.15 95% CI 0.03–0.66Authors' conclusion
In symptomatic participants with suspected CAD, identification of minimal risk by the PMRS guided a strategy of initially deferred testing. The strategy was safe with no observed adverse outcome events, fewer catheterizations without obstructive CAD, and similar symptom relief compared with usual testing.
Study context
- Population
- Symptomatic stable outpatients with suspected coronary artery disease (CAD) identified as minimal risk by the PROMISE minimal risk score (PMRS)minimal-risk of 2103 in PRECISE
- Participants
- 422 outpatients
- Comparison
- Deferred testing vs usual testing
- Deferred testingn = 214
- Usual testingn = 208reference
- Primary endpoint
- Composite of:
- All-cause death
- Nonfatal myocardial infarction (MI)
- Catheterization without obstructive CAD
- Follow-up
- 12 months
Methodological detailspragmatic, multicentre (65 North American and European sites), randomisation stratified by PMRS risk
- Pragmatic
- Multicentre (65 North American and European sites)
- Randomisation stratified by PMRS risk
Primary result
As reported in the abstract
Hazard ratio
0.15
95% CI 0.03–0.66
P = 0.01
Events by treatment group
Deferred testingvs Usual testing
HR 0.15 (95% CI 0.03–0.66); P = 0.01
Further findings
| Outcome | Usual testing | P value |
|---|---|---|
| Catheterization without obstructive CAD | 5.8% | P = 0.02 |
| Death or MI | ||
| Noncardiovascular death | 1 | |
| MI | 1 |
- Downstream testing in deferred testing group
- 36% · 76 of 214
- Downstream testing in deferred testing group: reasons: worsening (30%), uncontrolled (10%), new symptoms (6%), clinician preference (19%), participant preference (10%)
Frequent angina · 12 months
- Similar reduction of frequent angina from 70% at baseline to less than 20% in both groups
Original publication
Deferred Testing in Stable Outpatients With Suspected Coronary Artery Disease: A Prespecified Secondary Analysis of the PRECISE Randomized Clinical Trial. JAMA Cardiol. Published 1 October 2023. doi:10.
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