A long-term follow-up analysis of the PROMISE trial shows that stress testing in stable patients with suspected coronary artery disease (CAD) does not affect all-cause or cardiovascular (CV) death at 10 years. These data were reported by Pamela S. Douglas, MD, from Duke University School of Medicine in Durham, North Carolina, and colleagues, in a manuscript published online Wednesday in JAMA Cardiology. Patients with CAD symptoms often undergo noninvasive testing to help with diagnosis and future clinical management. The PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) randomized, multicenter trial took place from 2009 to 2014. Data from the National Death Index were used in the study, and the median follow-up time was 10.6 years. A total of 10,003 patients (mean age=61 years, 52.7% women) who were symptomatic for CAD and required testing were evaluated in the PROMISE trial. Patients were randomized 1:1 to receive functional (stress) testing versus anatomic, or coronary computed tomographic angiography (CTA), initial testing. This follow-up analysis compared the long-term outcomes in patients in both groups. Death, myocardial infarction (MI), unstable angina hospitalization or major procedural complication was the composite primary endpoint for the PROMISE trial. The primary endpoint for the present follow-up analysis was all-cause death, and CV death was the secondary endpoint. Upon enrollment into the PROMISE trial, 87.6% of patients presented with chest pain or dyspnea as symptoms. A total of 1,128 patients died (14.3% in the CTA arm, 14.4% in the stress test arm). No significant difference was found in CV mortality, but point estimates favored the CTA group (hazard ratio [HR]=0.84, 95% confidence interval [CI]=0.67-1.05; adjusted HR=0.89, 95% CI=0.41-1.94). No significant interactions were found between the two groups by age (pinteraction=0.19), gender (pinteraction=0.60) or race and ethnicity (pinteraction=0.47). Mild, moderate and severe findings of abnormality from the CTA group showed elevated adjusted HRs for death (1.99-3.44, p<0.001 for all) compared with the normal study results. In the stress testing group, the researchers noted that only severe abnormalities were relevant for prognostics (HR=1.45, 95% CI=1.10-1.91). At 90 days follow-up, patients who were alive showed no interactions between randomized testing and the use of statins, beta-blockers or antiplatelet agents. Overall, this follow-up analysis demonstrated that CTA and stress testing had similar long-term mortality outcomes in patients with suspected CAD. Source: Douglas PS, Stebbins A, Foldyna B, et al. Survival after initial stress testing vs anatomic testing in suspected coronary artery disease: Long-term follow-up of the PROMISE randomized clinical trial. JAMA. 2025 August 27 (Article in press). Image Credit: WavebreakMediaMicro – stock.adobe.com