First Scan, Then Treat: Ten Years of the SCOT-HEART Study

Abstract The widespread use of coronary computed tomography (CT) to exclude significant coronary stenoses and, more broadly, to achieve a more accurate assessment of cardiovascular risk through the evaluation of atherosclerosis has gained momentum in recent years, largely driven by growing criticism of the traditional ischemia-centred paradigm. The SCOT-HEART studies were among the first large randomised trials to promote the use of coronary CT in patients presenting with angina. The information provided by coronary CT translated into improved clinical outcomes through the adoption of more aggressive medical therapy, particularly lipid-lowering treatment, which was selectively prescribed to patients with evidence of atherosclerosis. The results of the SCOT-HEART 2 primary prevention trial are eagerly awaited and may further influence clinical practice. Finally, photon-counting CT, representing the latest technological advance, together with the application of artificial intelligence–based image analysis algorithms, may constitute an additional step forward in the use of CT imaging.