Trial reportBMJ open2014
Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: mid-term outcomes from the CECaT randomised controlled trial.
Trial report in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 4 syntheses or guidelines pooled it, 64 citations in OpenAlex.
- Prognostic relevance of a false-positive stress echocardiography response: a systematic review and meta-analysis.Open heart · 2025Pooled it
- Representation of Older Adults and Women in Randomized Trials of Noninvasive Imaging for Chest Pain.Circulation. Cardiovascular imaging · 2025Pooled it
- Cost-effectiveness of cardiovascular magnetic resonance imaging compared to common strategies in the diagnosis of coronary artery disease: a systematic review.Heart failure reviews · 2023Pooled it
- SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography.Journal of cardiovascular computed tomographyGuideline
- Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial.BMJ (Clinical research ed.) · 2016Trial
- Trial
- Cost-effectiveness of computed tomography coronary angiography versus conventional invasive coronary angiography.The European journal of health economics : HEPAC : health economics in prevention and care · 2015Trial
- A systematic review of modeling approaches to evaluate diagnostics programs for stable coronary heart disease: suggestions for future health economic models.Health economics review · 2026Review
- Real world hospital costs following stress echocardiography in the UK: a costing study from the EVAREST/BSE-NSTEP multi-entre study.Echo research and practice · 2023Article
- Evidence-based cardiovascular magnetic resonance cost-effectiveness calculator for the detection of significant coronary artery disease.Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2022Article
- Economic Analysis of the CADScor System for Ruling Out Coronary Artery Disease in England.PharmacoEconomics - open · 2022Article
- The indications and utility of adjunctive imaging modalities for chronic total occlusion (CTO) intervention.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Review
- The optimal diagnostic strategies for patient with coronary artery diseases and stable chest pain syndrome: a cost-effectiveness analysis.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2020Article
- Cardiac-CT and cardiac-MR cost-effectiveness: a literature review.La Radiologia medica · 2020Review
- CMR in the diagnosis of ischemic heart disease.La Radiologia medica · 2020Review
- Cost-effectiveness for imaging stable ischemic disease.The British journal of radiology · 2020Review
- Association Between Change in Circulating Progenitor Cells During Exercise Stress and Risk of Adverse Cardiovascular Events in Patients With Coronary Artery Disease.JAMA cardiology · 2020Article
- Cost-effectiveness analysis of stand-alone or combined non-invasive imaging tests for the diagnosis of stable coronary artery disease: results from the EVINCI study.The European journal of health economics : HEPAC : health economics in prevention and care · 2019Article
- Adenosine MPS in octogenarians: Looking safely into the future.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2019Article
- Using Parameter Constraints to Choose State Structures in Cost-Effectiveness Modelling.PharmacoEconomics · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 5 institutions in 2 countries.
Funding
Abstract
objectivesTo compare outcomes and cost-effectiveness of various initial imaging strategies in the management of stable chest pain in a long-term prospective randomised trial.
settingRegional cardiothoracic referral centre in the east of England.
participants898 patients (69% man) entered the study with 869 alive at 2 years of follow-up. Patients were included if they presented for assessment of stable chest pain with a positive exercise test and no prior history of ischaemic heart disease. Exclusion criteria were recent infarction, unstable symptoms or any contraindication to stress MRI. PRIMARY OUTCOME MEASURES: The primary outcomes of this follow-up study were survival up to a minimum of 2 years post-treatment, quality-adjusted survival and cost-utility of each strategy.
results898 patients were randomised. Compared with angiography, mortality was marginally higher in the groups randomised to cardiac MR (HR 2.6, 95% CI 1.1 to 6.2), but similar in the single photon emission CT-methoxyisobutylisonitrile (SPECT-MIBI; HR 1.0, 95% CI 0.4 to 2.9) and ECHO groups (HR 1.6, 95% CI 0.6 to 4.0). Although SPECT-MIBI was marginally superior to other non-invasive tests there were no other significant differences between the groups in mortality, quality-adjusted survival or costs.
conclusionsNon-invasive cardiac imaging can be used safely as the initial diagnostic test to diagnose coronary artery disease without adverse effects on patient outcomes or increased costs, relative to angiography. These results should be interpreted in the context of recent advances in imaging technology.
trial registrationISRCTN 47108462, UKCRN 3696.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.