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Acoustic-based rule-out of stable coronary artery disease : the FILTER-SCAD trial

Bjerking, Louise Hougesen ; Skak-Hansen, Kim Wadt ; Heitmann, Merete ; Hove, Jens Dahlgaard ; Haahr-Pedersen, Sune Ammentorp ; Engblom, Henrik LU ; Erlinge, David LU orcid ; Räder, Sune Bernd Emil Werner ; Brønnum-Schou, Jens and Biering-Sørensen, Tor , et al. (2025) In European Heart Journal 46(2). p.117-128
Abstract

Background and Aims. Overtesting of low-risk patients with suspect chronic coronary syndrome (CCS) is widespread. The acoustic-based coronary artery disease (CAD)-score has superior rule-out capabilities when added to pre-test probability (PTP). FILTER-SCAD tested whether providing a CAD-score and PTP to cardiologists was superior to PTP alone in limiting testing. Methods. At six Danish and Swedish outpatient clinics, patients with suspected new-onset CCS were randomized to either standard diagnostic examination (SDE) with PTP, or SDE plus CAD-score, and cardiologists provided with corresponding recommended diagnostic flowcharts. The primary endpoint was cumulative number of diagnostic tests at one year and key safety endpoint major... (More)

Background and Aims. Overtesting of low-risk patients with suspect chronic coronary syndrome (CCS) is widespread. The acoustic-based coronary artery disease (CAD)-score has superior rule-out capabilities when added to pre-test probability (PTP). FILTER-SCAD tested whether providing a CAD-score and PTP to cardiologists was superior to PTP alone in limiting testing. Methods. At six Danish and Swedish outpatient clinics, patients with suspected new-onset CCS were randomized to either standard diagnostic examination (SDE) with PTP, or SDE plus CAD-score, and cardiologists provided with corresponding recommended diagnostic flowcharts. The primary endpoint was cumulative number of diagnostic tests at one year and key safety endpoint major adverse cardiac events (MACE). Results. In total, 2008 patients (46% male, median age 63 years) were randomized from October 2019 to September 2022. When randomized to CAD-score (n = 1002), it was successfully measured in 94.5%. Overall, 13.5% had PTP ≤ 5%, and 39.5% had CAD-score ≤ 20. Testing was deferred in 22% with no differences in diagnostic tests between groups (P for superiority = .56). In the PTP ≤ 5% subgroup, the proportion with deferred testing increased from 28% to 52% (P < .001). Overall MACE was 2.4 per 100 person-years. Non-inferiority regarding safety was established, absolute risk difference 0.49% (95% confidence interval −1.96–0.97) (P for non-inferiority = .003). No differences were seen in angina-related health status or quality of life. Conclusions. The implementation strategy of providing cardiologists with a CAD-score alongside SDE did not reduce testing overall but indicated a possible role in patients with low CCS likelihood. Further strategies are warranted to address resistance to modifying diagnostic pathways in this patient population.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chronic coronary syndrome, Coronary artery disease, Deferred testing, Diagnostic strategy, Heart sound, Implementation strategy, Pre-test probability, Risk stratification
in
European Heart Journal
volume
46
issue
2
pages
12 pages
publisher
Oxford University Press
external identifiers
  • pmid:39217444
  • scopus:85214512003
ISSN
0195-668X
DOI
10.1093/eurheartj/ehae570
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
id
47d8cbaf-4953-40a2-a5c6-5272dac7ac62
date added to LUP
2025-03-14 14:02:37
date last changed
2025-06-06 21:27:48
@article{47d8cbaf-4953-40a2-a5c6-5272dac7ac62,
  abstract     = {{<p>Background and Aims. Overtesting of low-risk patients with suspect chronic coronary syndrome (CCS) is widespread. The acoustic-based coronary artery disease (CAD)-score has superior rule-out capabilities when added to pre-test probability (PTP). FILTER-SCAD tested whether providing a CAD-score and PTP to cardiologists was superior to PTP alone in limiting testing. Methods. At six Danish and Swedish outpatient clinics, patients with suspected new-onset CCS were randomized to either standard diagnostic examination (SDE) with PTP, or SDE plus CAD-score, and cardiologists provided with corresponding recommended diagnostic flowcharts. The primary endpoint was cumulative number of diagnostic tests at one year and key safety endpoint major adverse cardiac events (MACE). Results. In total, 2008 patients (46% male, median age 63 years) were randomized from October 2019 to September 2022. When randomized to CAD-score (n = 1002), it was successfully measured in 94.5%. Overall, 13.5% had PTP ≤ 5%, and 39.5% had CAD-score ≤ 20. Testing was deferred in 22% with no differences in diagnostic tests between groups (P for superiority = .56). In the PTP ≤ 5% subgroup, the proportion with deferred testing increased from 28% to 52% (P &lt; .001). Overall MACE was 2.4 per 100 person-years. Non-inferiority regarding safety was established, absolute risk difference 0.49% (95% confidence interval −1.96–0.97) (P for non-inferiority = .003). No differences were seen in angina-related health status or quality of life. Conclusions. The implementation strategy of providing cardiologists with a CAD-score alongside SDE did not reduce testing overall but indicated a possible role in patients with low CCS likelihood. Further strategies are warranted to address resistance to modifying diagnostic pathways in this patient population.</p>}},
  author       = {{Bjerking, Louise Hougesen and Skak-Hansen, Kim Wadt and Heitmann, Merete and Hove, Jens Dahlgaard and Haahr-Pedersen, Sune Ammentorp and Engblom, Henrik and Erlinge, David and Räder, Sune Bernd Emil Werner and Brønnum-Schou, Jens and Biering-Sørensen, Tor and Kjærgaard, Camilla Lyngby and Strange, Søren and Galatius, Søren and Prescott, Eva Irene Bossano}},
  issn         = {{0195-668X}},
  keywords     = {{Chronic coronary syndrome; Coronary artery disease; Deferred testing; Diagnostic strategy; Heart sound; Implementation strategy; Pre-test probability; Risk stratification}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{2}},
  pages        = {{117--128}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal}},
  title        = {{Acoustic-based rule-out of stable coronary artery disease : the FILTER-SCAD trial}},
  url          = {{http://dx.doi.org/10.1093/eurheartj/ehae570}},
  doi          = {{10.1093/eurheartj/ehae570}},
  volume       = {{46}},
  year         = {{2025}},
}