Objectives To investigate the impact of a CT-first strategy on all-cause and cardiovascular mortality in patients presenting with chest pain in outpatient cardiology clinics. Methods Patients with a first presentation of suspected angina pectoris were identified and their data linked to the registrations of Statistics Netherlands for information on mortality. The linked database consisted of 33 068 patients. CT-first patients were defined as patients with a CT calcium score and coronary CT angiography, within 6 weeks after their initial visit. Propensity score matching (1:5) was used to match patients with and without a CT-first strategy. After matching, 12 545 patients were included of which 2308 CT-first patients and 10 237 patients that underwent usual care. Results Mean age was 57 years, 56.3% were women and median follow-up was 4.9 years. All-cause mortality was significantly lower in CT-first patients (n=43, 1.9%) compared with patients without CT (n=363, 3.5%) (HR: 0.51, 95% CI 0.37 to 0.70). Furthermore, CT-first patients were more likely to receive cardiovascular preventative and antianginal medication (aspirin: 44.9% vs 27.1%, statins: 48.7% vs 30.3%, beta-blockers: 37.8% vs 25.5%, in CT-first and without CT-first patients, respectively) and to undergo downstream diagnostics and interventions (coronary interventions: 8.5% vs 5.7%, coronary angiography: 16.2% vs 10.6% in CT-first and without CT-first patients, respectively). Conclusions In a real-world regular care database, a CT-first strategy in patients suspected of angina pectoris was associated with a lowering of all-cause mortality. Data are available on reasonable request. The CCN data is not publicly available due to ethical and data protection constraints, but are available from the corresponding author on reasonable request. The results of presented survival analyses are based on calculations by the authors using non-public microdata from Statistics Netherlands. Under certain conditions, these microdata are accessible for statistical and scientific research. For further information: microdata@cbs.nl.

中文翻译：

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接受早期冠状动脉 CT 成像的首次胸痛患者的结果

目的 研究 CT 先行策略对心脏病门诊胸痛患者全因死亡率和心血管死亡率的影响。方法 确定首次出现疑似心绞痛的患者，并将他们的数据与荷兰统计局的死亡率信息登记相关联。链接的数据库包含 33 068 名患者。首次接受 CT 治疗的患者定义为在首次就诊后 6 周内进行 CT 钙化评分和冠状动脉 CT 血管造影的患者。倾向评分匹配 (1:5) 用于匹配采用和不采用 CT 优先策略的患者。匹配后，共纳入 12 545 例患者，其中 2 308 例 CT 先行患者和 10 237 例接受常规治疗的患者。结果 平均年龄为 57 岁，56.3% 为女性，中位随访时间为 4.9 年。与未接受 CT 的患者 (n=363, 3.5%) 相比，首先接受 CT 的患者 (n=43, 1.9%) 的全因死亡率显着降低（HR：0.51，95% CI 0.37 至 0.70）。此外，先行 CT 的患者更有可能接受心血管预防和抗心绞痛药物治疗（阿司匹林：44.9% vs 27.1%，他汀类药物：48.7% vs 30.3%，β 受体阻滞剂：37.8% vs 25.5%，先行 CT 和无 CT - 首诊患者）并接受下游诊断和干预（冠状动脉介入治疗：8.5% vs 5.7%，冠状动脉造影术：CT-first 和非 CT-first 患者分别为 16.2% 和 10.6%）。结论 在真实世界的常规护理数据库中，疑似心绞痛患者的 CT 优先策略与降低全因死亡率相关。可应合理要求提供数据。由于道德和数据保护限制，CCN 数据未公开，但可根据合理要求从相应作者处获得。所呈现的生存分析结果基于作者使用荷兰统计局的非公开微观数据进行的计算。在某些条件下，这些微观数据可用于统计和科学研究。如需更多信息：microdata@cbs.nl。