Survival After Initial Stress Testing vs Anatomic Testing in Suspected Coronary Artery Disease: Long-Term Follow-Up of the PROMISE Randomized Clinical Trial
Primary result · All-cause deathResult — go to the resultHazard ratio 0.98 95% CI 0.87–1.10Authors' conclusion
In long-term follow-up of the PROMISE randomized clinical trial, initial noninvasive test selection in patients with stable symptoms of suspected CAD did not affect all-cause or CV mortality at 10 years.
Study context
- Population
- Symptomatic outpatients requiring noninvasive testing for suspected coronary artery disease (CAD)
- Participants
- 10,003 outpatients
- Comparison
- Initial CTA vs initial stress testing
- Primary endpoint
- All-cause death (extended follow-up)
- Follow-up
- Median 10.6 (IQR 9.9-11.3) years
Methodological detailslong-term follow-up, multicentre, 193 outpatient sites in North America, 2024 National Death Index search; maximum follow-up 12.4 years
- Long-term follow-up
- Multicentre
- 193 outpatient sites in North America
- 2024 National Death Index search; maximum follow-up 12.4 years
Primary result
All-cause death
Hazard ratio
0.98
95% CI 0.87–1.10
Events by treatment group
CTAvs Stress
HR 0.98 (95% CI 0.87–1.10)
As reported in the abstract
Secondary outcomes
| Outcome | Estimate | |
|---|---|---|
| CV deathCTAvs Stress | HR 0.84 (95% CI 0.67–1.05) | |
| CV deathCTAvs Stress | adjusted HR 0.89 (95% CI 0.41–1.94) | |
| 0.512Ratio (log scale) |
Death by stress test result (severe abnormality)
| HR (95% CI) | ||
|---|---|---|
| Severe stress abnormalityOnly severe abnormality prognostically significant | 1.45 (1.10–1.91) | |
| 0.512Hazard ratio (log scale) |
Cardiovascular (CV) death
- No demonstrable difference in CV mortality
All-cause or CV death by age, gender, race and ethnicity (subgroups)
- No significant interactions with study arm
- Age interaction P = .19
- Gender interaction P = .60
- Race and ethnicity interaction P = .47
Death by CTA result (any abnormality vs normal)
- Mild, moderate or severe CTA abnormality: elevated adjusted HRs of death
- 1.99-3.44; all P < .001
Interaction of testing arm with statin, β-blocker, antiplatelet use (landmark, alive at 90 days)
- No interactions
- Statins interaction P = .22
- β-blockers interaction P = .76
- Antiplatelet interaction P = .49
Original publication
Survival After Initial Stress Testing vs Anatomic Testing in Suspected Coronary Artery Disease: Long-Term Follow-Up of the PROMISE Randomized Clinical Trial. JAMA Cardiol. Published 1 October 2025. doi:10.
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